Salvage therapy for BCG failure with intravesical sequential gemcitabine and docetaxel in patients with recurrent NMIBC

Authors

  • Charles-Antoine Garneau CHU de Québec Research Center-Université Laval, L’Hôtel-Dieu de Québec, Québec, Canada.
  • Nathalie Marcotte CHU de Québec- Université Laval
  • Louis Lacombe CHU de Québec- Université Laval
  • Yves Fradet
  • Vincent Fradet CHU de Québec-Université Laval, L’Hôtel-Dieu de Québec, Québec, Canada
  • Frédéric Pouliot CHU de Québec–Université Laval
  • Paul Toren CHU de Québec-Université Laval, L’Hôtel-Dieu de Québec, Québec, Canada
  • Michele Lodde Departments of Urology and Nuclear Medicine, Hotel Dieu de Quebec-Laval University Quebec, QC, Canada

DOI:

https://doi.org/10.5489/cuaj.8341

Keywords:

non muscle invasive bladder cancer, intravesical therapy, BCG, Gemcitabine docetaxel

Abstract

INTRODUCTION: Bacillus Calmette-Guérin (BCG) failure occurs in approximately 40% of patients with non-muscle-invasive bladder cancer (NMIBC) within two years. We describe our institutional experience with sequential intravesical gemcitabine and docetaxel (gem/doce) as salvage therapy post-BCG failure in patients who were not candidates for or declined radical cystectomy (RC).

METHODS: We retrospectively reviewed NMIBC patients with BCG failure who received gem/doce from April 2019 through October 2022 at the CHU de Québec–Université Laval. Patients received at least five weekly intravesical instillations according to published protocols. Patients who responded to gem/doce had maintenance instillations monthly for up to two years. Primary outcome was progression-free survival (PFS). Secondary outcomes included recurrence-free survival (RFS), cystectomy-free survival (CFS), cancer-specific survival (CSS), overall survival (OS), and treatment adverse events. Survival probabilities were estimated using the Kaplan-Meier method from the first gem/doce instillation.

RESULTS: Thirty-five patients with a median age of 78 years old were included in the study. The median followup time was 21 months (interquartile range 10–29). More than 25% of patients received two or more prior BCG induction treatments. Overall and MIBC PFS estimates at one year were 85% and 88%, and at two years, 60% and 70%, respectively. Adverse events occurred in 37% of the patients, but only two patients didn’t complete the treatment due to intolerance. Three patients underwent RC due to cancer progression. OS was 94% at two years.

CONCLUSIONS: With 60% of PFS at two years, gem/doce appears to be a safe and well-tolerated option for BCG failure patients. Further studies are needed to justify widespread use.

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Published

2023-10-23

How to Cite

Garneau, C.-A. ., Marcotte, N., Lacombe, L., Fradet, Y., Fradet, V., Pouliot, F., Toren, P., & Lodde, M. (2023). Salvage therapy for BCG failure with intravesical sequential gemcitabine and docetaxel in patients with recurrent NMIBC. Canadian Urological Association Journal, 18(2), 23–40. https://doi.org/10.5489/cuaj.8341

Issue

Vol. 18 No. 2 (2024): CUAJ February

Section

Original Research

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