Salvage Hyperthermic Gemcitabine and Docetaxel Combination Chemotherapy After BCG Failure in Non-Muscle Invasive Bladder Cancer Patients
AffiliationThe University of Arizona College of Medicine – Phoenix
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PublisherThe University of Arizona.
DescriptionA Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
AbstractIn patients with non-muscle invasive bladder cancer (NMIBC), intravesical BCG has been shown to reduce the rate of disease recurrence and disease progression, as well as improve disease-specific survival. While Bacillus Calmette-Guerin (BCG) has become the gold-standard therapy for NMIBC, there are still patients who fail this therapy or are not good candidates for it. Although a radical cystectomy is recommended when BCG is failed, some patients either desire bladder preservation or are not surgical candidates. Thus, further exploration into salvage chemo therapy treatments should be done to provide these patients with an alternative treatment option. The purpose of this study is to analyze if combination Gemcitabine and Docetaxel chemotherapy (GEM/DOCE) is a successful salvage option in adults who have failed or cannot tolerate BCG therapy for NMIBC, and are poor surgical candidates for a radical cystectomy (RC) or desire bladder preservation. In this retrospective study, 60 patients were included. Overall treatment success was 83% (50/60) at first surveillance, 69% at 1-year, and 55% at 2-years after induction of GEM/DOCE in the entire cohort, and 90%(53/51) at first surveillance, 74% at 1-year, and 56% at 2-years in the BCG-failure patients. These success rates are quite favorable and warrant further investigation in a prospective manner to further optimize this salvage protocol for patients who remain a challenge to treat.