Intravesical gemcitabine for high risk, nonmuscle invasive bladder cancer after bacillus Calmette-Guérin treatment failure Journal Article

Authors: Sternberg, I. A.; Dalbagni, G.; Chen, L. Y.; Donat, S. M.; Bochner, B. H.; Herr, H. W.
Article Title: Intravesical gemcitabine for high risk, nonmuscle invasive bladder cancer after bacillus Calmette-Guérin treatment failure
Abstract: Purpose: We report our experience with intravesical gemcitabine for bladder cancer after failed bacillus Calmette-Guérin treatment. Materials and Methods: We retrospectively reviewed the records of patients at our cancer center treated with intravesical gemcitabine after bacillus Calmette- Guérin failure. We estimated progression-free, recurrence-free and cancer specific survival using the cumulative incidence function, considering death from another cause as a competing risk. Comparisons were made using the Gray test. Overall survival was estimated using the Kaplan-Meier method and differences were compared with the log rank test. Results: Of 69 patients treated with intravesical gemcitabine 37 had bacillus Calmette-Guérin refractory disease. Median followup in progression-free patients was 3.3 years. Progression-free and cancer specific survival were similar in patients with refractory disease and those with other types of bacillus Calmette- Guérin failure. Overall survival was lower in patients with refractory disease (58% vs 71%) but this was not statistically significant (p = 0.096). Of the patients 27 patients experienced a complete response. Progression-free, cancer specific and overall survival did not differ significantly between patients with and without a complete response. Cystectomy was subsequently performed in 20 patients. Those with a complete response had a delayed time to cystectomy and no muscle invasive bladder cancer at cystectomy. There were no serious adverse events and only a minority of patients discontinued treatment due to adverse events. Conclusions: In our experience intravesical gemcitabine should be considered after bacillus Calmette-Guérin failure in patients with bladder cancer who refuse radical cystectomy or who are not candidates for major surgery. © 2013 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION AND RESEARCH, INC.
Keywords: adult; cancer chemotherapy; cancer survival; controlled study; treatment response; aged; cancer surgery; treatment failure; major clinical study; overall survival; constipation; fatigue; cancer recurrence; interferon; cancer risk; diarrhea; drug withdrawal; multimodality cancer therapy; gemcitabine; cancer patient; comparative study; outcome assessment; recurrent cancer; follow up; cancer incidence; bcg vaccine; progression free survival; nausea; thrombocytopenia; deep vein thrombosis; medical record review; retrospective study; urinary bladder neoplasms; hematuria; cancer mortality; fever; rash; cancer center; death; cancer specific survival; cancer immunization; cystectomy; urinary bladder; urinary tract infection; urinary urgency; mitomycin; lung infection; drug treatment failure; dysuria; recurrence free survival; bcg vaccination; bladder neck stenosis; non muscle invasive bladder cancer; human; male; female; priority journal; article
Journal Title: Journal of Urology
Volume: 190
Issue: 5
ISSN: 0022-5347
Publisher: Elsevier Science, Inc.  
Date Published: 2013-11-01
Start Page: 1686
End Page: 1691
Language: English
DOI: 10.1016/j.juro.2013.04.120
PROVIDER: scopus
PUBMED: 23665400
Notes: Cited By (since 1996):1 -- Export Date: 2 January 2014 -- CODEN: JOURA -- Source: Scopus
Altmetric Score
MSK Authors
  1. Guido Dalbagni
    256 Dalbagni
  2. Sherri M Donat
    135 Donat
  3. Bernard Bochner
    330 Bochner
  4. Harry W Herr
    412 Herr
  5. Ling Yun Chen
    16 Chen