Skip to main content

Advertisement

Log in

Experience with Sequential Intravesical Gemcitabine and Docetaxel as Salvage Therapy for Non-Muscle Invasive Bladder Cancer

  • Urothelial Cancer (A Sagalowsky, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Patients with high-grade muscle invasive bladder cancer (NMIBC) receive intravesical therapy with bacillus Calmette-Guérin (BCG) as the well-established standard-of-care. However, even with prompt induction of intravesical therapy, approximately 40 % of patients will recur within 2 years. For patients who fail BCG, options include radical cystectomy, repeat BCG therapy, or alternative intravesical salvage therapy. In this review, we will discuss the most recent published evidence on salvage intravesical therapy with an emphasis on a more in-depth report of our therapeutic strategy with sequential gemcitabine and docetaxel intravesical therapy for this treatment-refractory population. In addition, we will provide practical advice on our approach to this challenging patient population including the use of operative staging to aid early identification of treatment failures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as:• Of importance •• Of major importance

  1. Brosman SA. Experience with bacillus Calmette-Guérin in patients with superficial bladder carcinoma. J Urol. 1982;128:27–30.

    CAS  PubMed  Google Scholar 

  2. Babjuk M, Burger M, Zigeuner R, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2013 European Association of Urology. Eur Urol. 2013;64:639–53.

    Article  PubMed  Google Scholar 

  3. Hall MC, Chang SS, Dalbagni G, et al. Guideline for the management of nonmuscle invasive bladder cancer (stages Ta, T1, and Tis): 2007 update. J Urol. 2007;178:2314–30.

    Article  PubMed  Google Scholar 

  4. Sylvester RJ, van der Meijden AP, Lamm DL. Intavesical bacillus Calmette-Guérin reduces the risk of progression in patients with superficial bladder cancer: a meta-analysis of the published results of randomized clinical trials. J Urol. 2002;168:1964–70.

    Article  CAS  PubMed  Google Scholar 

  5. Chamie K, Saigal CS, Lai J, Urologic Diseases in America Project, et al. Quality of care in patients with bladder cancer: a case report? Cancer. 2012;118:1412–21.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Nepple KG, Lightfoot AJ, Rosevear HM, O’Donnell MA, Lamm DL, Bladder Cancer Genitourinary Oncology Study Group. Bacillus Calmette-Guérin with or without interferon alpha-2b and megadose versus recommended daily allowance vitamins during induction and maintenance intravesical treatment of nonmuscle invasive bladder cancer. J Urol. 2010;184:1915–9.

    Article  PubMed  Google Scholar 

  7. Fernandez-Gomez J, Madero R, Solsona E, et al. Predicting nonmuscle invasive bladder cancer recurrence and progression in patients treated with bacillus Calmette-Guérin: the CUETO scoring model. J Urol. 2009;182:2195–203.

    Article  PubMed  Google Scholar 

  8. Rosevear HM, Lightfoot AJ, Nepple KG, O'Donnell MA. Usefulness of the Spanish Urological Club for Oncological Treatment scoring model to predict nonmuscle invasive bladder cancer recurrence in patients treated with intravesical bacillus Calmette-Guérin plus interferon-alpha. J Urol. 2011;185:67–71.

    Article  PubMed  Google Scholar 

  9. Lee CT, Madii R, Daignault S, et al. Cystectomy delay more than 3 months from initial bladder cancer diagnosis results in decreased disease specific and overall survival. J Urol. 2006;175:1262–7.

    Article  PubMed  Google Scholar 

  10. Herr WH, Sogani PC. Does early cystectomy improve the survival of patients with high-risk superficial bladder tumors? J Urol. 2001;166:1296–9.

    Article  CAS  PubMed  Google Scholar 

  11. Shabsigh A, Korets R, Vora KC, et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol. 2009;55:164–74.

    Article  PubMed  Google Scholar 

  12. American Urological Association. Policy blog: important updates on BCG availability. September 9, 2014. http://www.auanet.org/advocacy/policy-blog.cfm.

  13. Sjödahl G, Lövgren K, Lauss M, et al. Toward a molecular pathologic classification of urothelial carcinoma. Am J Pathol. 2013;183:681–91.

    Article  PubMed  Google Scholar 

  14. Catalona WJ, Hudson MA, Gillen DP, Andriole GL, Ratliff TL. Risks and benefits of repeated courses of intravesical bacillus Calmette-Guérin therapy for superficial bladder cancer. J Urol. 1987;137:220–4.

    CAS  PubMed  Google Scholar 

  15. O’Donnell MA, Boehle A. Treatment options for BCG failures. World J Urol. 2006;24:481–7.

    Article  PubMed  Google Scholar 

  16. Joudi FN, Smith BJ, O’Donnell MA, National BCG-Interferon Phase 2 Investigator Group. Final results from a national multicenter phase II trial of combination bacillus Calmette-Guérin plus interferon alpha-2B for reducing recurrence of superficial bladder cancer. Urol Oncol. 2006;24:344–8.

    Article  CAS  PubMed  Google Scholar 

  17. Steinberg G, Bahnson R, Brosman S, Middleton R, Wajsman Z, Wehle M. Efficacy and safety of valrubicin for the treatment of bacillus Calmette-Guérin refractory carcinoma in situ of the bladder. The Valrubicin Study Group. J Urol. 2000;163:761–7.

    Article  CAS  PubMed  Google Scholar 

  18. Marchetti A, Wang L, Magar R, et al. Management of patients with Bacilli Calmette-Guérin-refractory carcinoma in situ of the urinary bladder: cost implications of a clinical trial for valrubicin. Clin Ther. 2000;22:422–38.

    Article  CAS  PubMed  Google Scholar 

  19. Dalbagni G, Russo P, Bochner B, et al. Phase II trial of intravesical gemcitabine in bacille Calmette-Guérin-refractory transitional cell carcinoma of the bladder. J Clin Oncol. 2006;24:2729–34.

    Article  CAS  PubMed  Google Scholar 

  20. Bartoletti R, Cai T, Gacci M, et al. Intravesical gemcitabine therapy for superficial transitional cell carcinoma: results of a phase II prospective multicenter study. TUR (Toscana Urologia) Group. Urology. 2005;66:726–31.

    Article  PubMed  Google Scholar 

  21. Gontero P, Marini L, Frea B. Intravesical gemcitabine for superficial bladder cancer: rationale for a new treatment option. BJU Int. 2005;96:970–6.

    Article  CAS  PubMed  Google Scholar 

  22. Mohanty NK, Nayak RL, Vasudeva P, Arora RP. Intravesical gemcitabine in management of BCG refractory superficial TCC of urinary bladder-our experience. Urol Oncol. 2008;26:616–9.

    Article  CAS  PubMed  Google Scholar 

  23. Skinner EC, Goldman B, Sakr WA, et al. SWOG S0353: phase II trial of intravesical gemcitabine in patients with nonmuscle invasive bladder cancer and recurrence after 2 prior courses of intravesical bacillus Calmette-Guérin. J Urol. 2013;190:1200–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Barlow LJ, McKiernan JM, Benson MC. Long-term survival outcomes with intravesical docetaxel for recurrent nonmuscle invasive bladder cancer after previous bacillus Calmette-Guérin therapy. J Urol. 2013;189:834–9.

    Article  CAS  PubMed  Google Scholar 

  25. Lightfoot AJ, Breyer BN, Rosevear HM, Erickson BA, Konety BR, O’Donnell MA. Multi-institutional analysis of sequential intravesical gemcitabine and mitomycin C chemotherapy for non-muscle invasive bladder cancer. Urol Oncol. 2014;32:35–e15. Formal operative restaging with biopsy should be a consideration for patients undergoing salvage intravesical therapy.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Holzbeierlein JM, Waldsachs Isett W. Supply and demand: dealing with drug shortages. In Global connections. Linthicum MD: American Urological Association; 2013, pp. 4–8.

  27. Steinberg RL, Thomas LJ, O’Donnell MA, Nepple KG. Sequential intravesical gemcitabine and docetaxel for salvage treatment of non-muscle invasive bladder cancer. Bladder Cancer. 2015;1:65–72. To our knowledge, the first reported experience with sequential gemcitabine and docetaxel salvage therapy.

    Article  Google Scholar 

  28. Millán-Rodriguez F, Chéchile-Toniolo G, Salvador-Bayarri J, Palou J, Algaba F, Vincente-Rodríguez J. Primary superficial bladder cancer risk groups according to progression, mortality and recurrence. J Urol. 2000;164:680–4.

    Article  PubMed  Google Scholar 

  29. Lightfoot AJ, Rosevear HM, Nepple KG, O’Donnell MA. Role of routine transurethral biopsy and isolated upper tract cytology after intravesical treatment of high-grade non-muscle invasive bladder cancer. Int J Urol. 2012;19:988–93.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kenneth G. Nepple.

Ethics declarations

Conflict of Interest

Kyla N. Velaer, Ryan L. Steinberg, Lewis J. Thomas, Michael A. O’Donnell, and Kenneth G. Nepple each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Urothelial Cancer

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Velaer, K.N., Steinberg, R.L., Thomas, L.J. et al. Experience with Sequential Intravesical Gemcitabine and Docetaxel as Salvage Therapy for Non-Muscle Invasive Bladder Cancer. Curr Urol Rep 17, 38 (2016). https://doi.org/10.1007/s11934-016-0594-2

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11934-016-0594-2

Keywords

Navigation