Timing of Chemotherapy After Bladder Tumor Surgery Doesn't Affect Recurrence Rates

What is it about?

This study investigates the timing of induction therapy using sequential intravesical gemcitabine and docetaxel (Gem/Doce) following transurethral resection of bladder tumor (TURBT) in patients with high- or intermediate-risk nonmuscle-invasive bladder cancer (NMIBC). Conducted at the University of Iowa, the retrospective review included treatment-naïve patients from 2013 to 2024 who were stratified by quartiles based on time from TURBT to first Gem/Doce instillation. This study found no significant differences in recurrence-free survival (RFS) across quartiles, with 2-year RFS rates ranging from 72% to 80%. Adverse events were similarly distributed across quartiles, with bladder spasms being a predominant factor in high-risk patients. While early treatment year and high-risk status were initially associated with higher odds of adverse events, multivariable analysis indicated that high-risk status remained significant. The findings suggest that timing between TURBT and Gem/Doce induction does not significantly impact recurrence or adverse event rates, contrasting with the delayed induction strategy traditionally recommended for intravesical BCG therapy.

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Why is it important?

This study investigates the timing of induction therapy with sequential intravesical gemcitabine and docetaxel (Gem/Doce) following transurethral resection of bladder tumor (TURBT) in patients with high- or intermediate-risk nonmuscle-invasive bladder cancer (NMIBC). The broader relevance of this research lies in its potential to optimize treatment protocols and improve patient outcomes by examining whether the timing of induction impacts recurrence and treatment-related toxicity. The research provides valuable insights into the management of NMIBC and contributes to the ongoing discussion regarding the scheduling of postoperative treatments. Key Takeaways: 1. This study reveals that the timing of Gem/Doce induction therapy following TURBT, when stratified by quartile, does not significantly affect recurrence-free survival (RFS) outcomes in patients with high- or intermediate-risk NMIBC. 2. The analysis indicates that adverse events (AEs) associated with Gem/Doce treatment occur at similar rates across different timing quartiles, with high-risk patient status and earlier treatment years being associated with increased odds of developing AEs. 3. Despite limited data supporting the ideal timing of induction therapy post-TURBT, this study supports the hypothesis that early intervention with Gem/Doce does not compromise oncological outcomes or increase adverse events, contrasting with traditional guidelines that advocate delayed induction to prevent systemic absorption.