Non-muscle-invasive bladder cancer patients now have an effective and well-tolerated option for salvage treatment thanks to the introduction of intravenous gemcitabine-docetaxel. However, additional rescue interventions are required for future recurrences or intolerance, especially when cystectomy is denied or not an option. Although valrubicin has been licensed by the U.S. Food and Drug Administration (FDA) for treating bacillus Calmette-Guérin-resistant illness, it has shown limited efficacy when used alone. Researchers present their findings from using consecutive intravesical valrubicin and docetaxel as rescue therapy for locally advanced, non-muscle-invasive bladder cancer. From April 2013 through June 2021, they identified all patients with recurrent non-muscle-invasive bladder cancer who were given valrubicin and docetaxel. Intravesical instillations of 800 mg of valrubicin and 37.5 mg of docetaxel were given to patients weekly in a sequential fashion for 6 weeks. If they were disease-free at the initial checkup, they started a 2-year maintenance program of once-monthly visits. The Kaplan-Meier method was used to determine the primary outcome, which was overall survival without a recurrence of the disease.  About 75 individuals were enrolled in the study, and their median follow-up duration was 21 months (IQR: 13-37). Roughly 2 years after treatment, 12 patients with low-grade illness had a 73% recurrence-free survival rate. There was a 38% high-grade recurrence-free survival rate at 2 years among 63 patients with the recurrent high-grade illness. Recurrence-free survival was similar for patients with and without carcinoma in situ (P =.63). About 42 patients (56%) were diagnosed with carcinoma in situ. While 10 patients underwent a cystectomy on their bladder cancer, 2 succumbed to the disease. At 2 years, the overall survival rate for patients with the high-grade disease was 87%, the cancer-specific survival rate was 96%, and the percentage of patients who were cancer-free after undergoing a cystectomy was 84%. Bladder spasms (n = 18), urine frequency (n = 10), and dysuria (n = 8) were the most common adverse effects. Only 2 individuals were unable to undergo induction with valrubicin and docetaxel. These findings imply that valrubicin plus docetaxel is a viable rescue treatment for patients with recurrent non-muscle-invasive bladder cancer in a strongly pretreated group. More long-term studies are needed.

Source: auajournals.org/doi/full/10.1097/JU.0000000000002848