Sequential intravesical gemcitabine and docetaxel therapy in patients with nonmuscle invasive bladder cancer: a systematic review and meta-analysis

Abstract

Purpose of reviewShortages in intravesical Bacillus Calmette-Guérin (BCG) immunotherapy represent a challenge in the management of high-risk nonmuscle invasive bladder cancer (HR-NMIBC). This study aimed to review the efficacy and safety of intravesical gemcitabine (GEM) and docetaxel (DOCE) for BCG-naive and unresponsive HR-NMIBC.Recent findingsWe identified six studies eligible for quantitative analysis through a systematic search according to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statement. In the two studies in the BCG-naive setting, 1-year and 2-year pooled recurrence-free survival (RFS) were 86 and 84%, respectively. In the two studies in the BCG unresponsive setting, 6-month, 1-year and 2-year pooled high-grade recurrence-free survival (HG-RFS) were 80, 66 and 51%, respectively. Cumulative data from four studies revealed that 2.3% of patients could not complete induction therapy and 6.9% experienced treatment delay or dose reduction due to adverse events.SummaryDespite the preliminary data and based on a small sample size, intravesical GEM/DOCE therapy is a highly promising combination yielding an effective and well tolerated alternative to BCG when indicated. Further large, well designed comparative studies with BCG are needed.

Intermediate and high-risk non-muscle-invasive bladder cancer: an overview of epidemiology, burden, and unmet needs

“…However, the comparison of contemporary gemcitabine-docetaxel patients with a historic BCG cohort, with different follow-up periods and the use of a non-standard reduced-dose BCG-IFN-2a combination treatment as comparator, limit the interpretation of these results. A recent systematic review of sequential gemcitabinedocetaxel therapy concluded that the therapy was promising, but that additional large studies of good quality that compare gemcitabine-docetaxel with BCG are necessary (133).…”

Intravesical Contrast-Enhanced MRI: A Potential Tool for Bladder Cancer Surveillance and Staging

“…The cost of the diagnosis and care of bladder cancer is soaring due to several factors: the rise in prevalence, a high recurrence rate of 75-80% [4], and the dependence of the standard of care on expensive operating room resources for BCa staging via transurethral resection of bladder tumor (TURBT). Over 98% of BCas are histologically confirmed to be urothelial cell carcinomas.…”