(UroToday.com) The American Urological Association (AUA) 2025 Annual Meeting, held in Las Vegas, NV, was host to a non-invasive bladder cancer interactive poster session. Dr. Kaushik Kolanukuduru presented the results of a study comparing sequential gemcitabine + docetaxel (Gem/Doce) to BCG for non-muscle invasive bladder cancer (NIMBC) patients across the AUA risk stratification system.
The AUA risk stratification system has traditionally been based on pathological severity and BCG responses. Dr. Kolanukuduru argued that a knowledge gap exists with regards to the applicability of the AUA risk classification to patients receiving Gem/Doce. They sought to determine the recurrence and progression rates in patients with intermediate risk (IR) and high risk (HR) NMIBC treated with BCG and Gem/Doce to determine the validity of AUA risk stratification in Gem/Doce patients.
This study included NMIBC patients treated between 2012 and 2024. Patients were stratified into IR NMIBC and HR NMIBC, per the AUA guidelines. Survival analyses using the Kaplan-Meier method and Cox proportional hazards modeling were used to evaluate high-grade recurrence free survival (HG-RFS) and progression free survival (PFS) in BCG- and Gem/Doce-treated patients, by risk group.
This analysis included 483 patients who received intravesical therapy for NMIBC (BCG: 371; Gem/Doce: 112). Among the BCG and Gem/Doce-treated patients, the AUA risk group was as follows:
- BCG:
- IR: 83 (22.4%)
- HR: 288 (77.6%)
- Gem/Doce:
- IR: 67 (59.8%)
- HR: 45 (40.2%)
The median ages of patients in the BCG and Gem/Doce groups were 71 and 72 years, respectively.
The 2-year HG-RFS rates were as follows:
- BCG:
- IR: 82.5%
- HR: 58.2% (p-value for comparison <0.01)
- Gem/Doce:
- IR: 66.2%
- HR: 67.2% (p-value for comparison 0.7)
The 2-year PFS rates were as follows:
- BCG:
- IR: 98.6%
- HR: 86.3% (p-value for comparison <0.01)
- Gem/Doce:
- IR: 87.2%
- HR: 87%% (p-value for comparison= 0.8)
On multivariable Cox regression analysis, HR NMIBC patients receiving BCG had increased rates of high-grade recurrence (HR: 2.8, 95% CI: 1.6–4.9, p<0.01) and progression (HR: 6.3, 95% CI: 1.9–20.5, p=0.02), when compared to IR NMIBC. However, in patients receiving Gem/Doce, HR NMIBC patients did not have worse high-grade recurrence (HR: 1.5, 95% CI: 0.71–3.4, p=0.26) or progression rates (HR: 1.1, 95% CI: 0.4–3.2, p=0.8).
Dr. Kolanukuduru concluded that IR NMIBC and HR NMIBC patients who receive Gem/Doce have similar HG-RFS and PFS rates, calling for renewed risk stratifications for Gem/Doce patients. He argued that multi-institutional studies are required to confirm these findings.
Presented by: Kaushik Kolanukuduru, MBBS, Research Fellow, Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
Written by: Rashid K. Sayyid, MD, MSc – Robotic Urologic Oncology Fellow at The University of Southern California, @rksayyid on Twitter during the 2025 American Urological Association (AUA) annual meeting held in Las Vegas, NV, Saturday, April 26 - Tuesday, April 29, 2025