(UroToday.com) The 2025 SESAUA annual meeting featured a bladder cancer session and a presentation by Dr. Gabrielle Yankelevich discussing a multicenter experience with first-line intravesical gemcitabine + docetaxel versus BCG for high risk non-muscle invasive bladder cancer.
During the modern BCG shortages, sequential intravesical chemotherapy (gemcitabine + docetaxel) therapy has gained traction for treatment patients with treatment-naïve, high risk non-muscle invasive bladder cancer. In this study, Dr. Yankelevich assessed if gemcitabine + docetaxel was associated with similar oncologic efficacy to BCG as first line treatment of high risk non-muscle invasive bladder cancer.
This was a multi-center, retrospective cohort study of 136 patients with high risk non-muscle invasive bladder cancer that initiated intravesical treatment between August 2020 and August 2023. Included patients required gemcitabine + docetaxel or BCG induction and had the option for maintenance therapy. Patients with a history of any upper tract urothelial carcinoma were excluded. The primary outcome was histologic, high-grade bladder cancer recurrence during routine surveillance (quarterly cystoscopy and urine cytology). Oncologic efficacy (high-grade recurrence free survival) of first-line gemcitabine + docetaxel versus BCG at 12- and 24-months after initiation was compared with the Kaplan-Meier method.
During an overall median follow up of 21 months, a cohort of 55 patients received gemcitabine + docetaxel compared to the contemporary cohort of 81 patients that received BCG. There were comparable distributions of bladder cancer pathologies for gemcitabine + docetaxel and BCG:
- Any HG Ta: 62% versus 51%
- Any T1: 39% versus 36%
- Any CIS: 28% versus 18%
There were 30 high-grade recurrences identified (gemcitabine + docetaxel: 12 versus BCG: 18). Gemcitabine + docetaxel did not have significantly differing oncologic efficacy compared to BCG:
- 12-months recurrence free survival: 87% versus 84%
- 24-months recurrence free survival: 74% vs 81%
Dr. Yankelevich concluded her presentation discussing a multicenter experience with first-line intravesical gemcitabine + docetaxel versus BCG for high risk non-muscle invasive bladder cancer with the following take-home points:
- In this multicenter study, first-line gemcitabine + docetaxel for high risk non-muscle invasive bladder cancer yields comparable oncologic efficacy to BCG at intermediate-term follow up
- As clinical trials for patients with treatment-naïve, high risk non-muscle invasive bladder cancer await completion (ie. the BRIDGE trial), this study suggests that gemcitabine + docetaxel should remain a treatment option
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the Southeastern Section of the American Urological Association (SESAUA) 2025 Annual Meeting, Nashville, TN, Wed, Mar 12 – Sat, Mar 15, 2025.