The following is a summary of “Sequential intravesical gemcitabine/docetaxel provides a durable remission in recurrent high-risk NMIBC following BCG therapy,” published in the November 2023 issue of Urology by Yim, et al.

Bacillus Calmette–Guerin (BCG) is usually given to people with high-risk nonmuscle invasive bladder cancer (NMIBC), but half of those people get the disease back. There aren’t many intravenous treatments for NMIBC that don’t respond to BCG. For a study, researchers sought to talk about the safety, effectiveness, and different reactions of gemcitabine/docetaxel (gem/doce) given one after the other based on the BCG failure classification. They looked back at patients from five different institutions who were treated with induction intravenous gem/doce (≥5/6 installations) for high-risk NMIBC that came back after BCG treatment from May 2018 to December 2021. People who did not have a high-grade (HG) return on monitoring cystoscopy were given maintenance treatment. 

They used Kaplan–Meier curves and Cox regression models to look at survival rates and factors that raise the chance of getting the disease again. Their group had 102 people with NMIBC that did not respond to BCG. The average age was 72 years old, and the average time between follow-ups was 18 months. After 6 months, 12 months, and 24 months, 78%, 65%, and 49% of people with high-grade return were still alive. 20 people had major cystectomy (median 15.5 months from the start of treatment). 6 of the patients got the muscle-invasive disease. 57% of patients had mild to moderate adverse effects (AE), but only 6.9% had to wait longer for their treatment to start. 

Many people reported frequent or urgent urination (41%), and 21% had trouble urinating. Patients with BCG refractory disease were more likely than patients with BCG relapse disease to get HG again (HR 2.14; 95% CI 1.02–4.49). Sequential intravenous gem/doce is a good and safe option for early cystectomy for people who have had a return after BCG treatment. People who have BCG recurrent disease are more likely to get better with extra intravenous gem/doce. More research with a planned study is needed right away.

Source: sciencedirect.com/science/article/abs/pii/S1078143923002296