Comparing Two Treatments for Bladder Cancer After Initial Therapy Fails

What is it about?

This study retrospectively evaluated outcomes in patients with high-grade non-muscle invasive bladder cancer (NMIBC) who experienced recurrence post-induction Bacillus Calmette-Guérin (BCG) therapy, comparing re-induction BCG to sequential intravesical gemcitabine-docetaxel (Gem/Doce) therapy. Conducted at a multi-site tertiary institution in Victoria, Australia, This study included patients treated from 2017 to 2023. Among 140 patients who received induction BCG, 30 showed persistent high-grade NMIBC, with five undergoing re-induction BCG and 11 receiving Gem/Doce. The initial post-treatment cystoscopy revealed recurrence in one re-induction BCG patient and two Gem/Doce patients. This study found that Gem/Doce was better tolerated with fewer adverse events compared to re-induction BCG, while both treatments exhibited comparable recurrence rates at three months. The introduction of Gem/Doce in 2021 provided a promising alternative for BCG-failure NMIBC, especially given the ongoing global BCG shortage.

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Why is it important?

This study investigates the comparative outcomes of re-induction Bacillus Calmette-Guérin (BCG) versus sequential intravesical gemcitabine-docetaxel (Gem/Doce) therapy in patients with high-grade non-muscle invasive bladder cancer (NMIBC) following initial BCG failure. As recurrent NMIBC poses significant challenges and the standard radical cystectomy is not suitable for all patients, exploring alternative bladder-preserving treatments is crucial. This research is particularly relevant in light of the ongoing global BCG shortage, highlighting the need for effective alternatives. Key Takeaways: 1. This study demonstrates that intravesical Gem/Doce therapy is associated with fewer adverse events compared to re-induction BCG, suggesting better tolerability for patients with BCG-failure NMIBC. 2. Findings reveal that the recurrence rates at three months post-treatment are comparable between patients treated with Gem/Doce and those who underwent re-induction BCG, indicating similar efficacy in the short term. 3. The research highlights that while re-induction BCG is associated with a broader range of side effects, both treatment groups experienced mild and self-limiting symptoms, with no hospitalizations required post-treatment.