Intravesical gemcitabine/docetaxel as an alternative therapy for patients with non-muscle-invasive bladder cancer (Better results than with TB vaccine use)

Medical Xpress / Expert Opinion on Pharmacotherapy ^ | Feb. 23, 2024 | Michael A. O'Donnell / Mohamad Abou Chakra et al

[ConservativeMind]

Bladder cancer is one of the more common cancers worldwide.

Intravesical bacillus Calmette-Guerin (tuberculosis vaccine) has been used as adjuvant therapy by urologists since 1976.

Unfortunately, BCG fails approximately 40% of patients in two years.

Since 2012, BCG has been in a worldwide shortage situation.

One of the most promising new strategies for NMIBC is the combination of intravesical chemotherapy drugs used as sequential therapy, one drug after the other, with one-hour bladder dwell time for each drug. Initial results with gemcitabine (Gem) and mitomycin C (MMC) appeared promising but shortages in MMC led to the need to substitute docetaxel (Doce) for MMC to create Gem/Doce.

However, while reports of Gem/MMC were limited to failed BCG patients, with the evolving BCG shortage, Gem/Doce found a use for not only failed BCG patients but as a substitute for patients never previously receiving BCG (BCG naïve).

Interestingly, Gem/MMC performed similarly well for BCG failures. In terms of side effects, the documented toxicity of Gem/Doce was found to be generally mild. The results for Gem/MMC were also generally mild.

In simple terms, intravesical Gem/Doce was shown to be an effective and safe treatment for NMIBC if used as first-line therapy in place of BCG and as rescue therapy after BCG failure. Gem/MMC fared near equally well for BCG failure patients but these results were based on less than 100 patients treated.

One added notable feature of Gem/Doce is its cost effectiveness. The mean cost per patient at two years is estimated at approximately $12,363 for BCG therapy vs. $7,090 for Gem/Doce (almost saving half of the treatment cost). Newer immunotherapy (such as pembrolizumab) and gene therapy (Nadofaragene firadenovec) are much more expensive despite being less effective.

[ConservativeMind]

More at the link that I wasn’t able to git into the 300 words, but it looks like these therapies are better options than the TB vaccine has been, across multiple levels of concern (efficacy, side effects, and availability).

[ConservativeMind]

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[Williams]

Ty very much. I don’t know much about bladder cancer but from what I was told of a friend’s treatment, it sounded like they physically or chemically scraped the lining of the blader as an initial treatment?
Then on follow up, I believe they filled the bladder with a chemo treatment, possibly like what you describe here.