Mp16-18 Combination Regimen of Intravesical Docetaxel, Gemcitabine, and Cisplatin in Patients With BCG-Unresponsive Non-Muscle Invasive Urothelial Carcinoma of the Bladder

You have accessJournal of UrologyBladder Cancer: Non-invasive I (MP16)1 May 2024MP16-18 COMBINATION REGIMEN OF INTRAVESICAL DOCETAXEL, GEMCITABINE, AND CISPLATIN IN PATIENTS WITH BCG-UNRESPONSIVE NON-MUSCLE INVASIVE UROTHELIAL CARCINOMA OF THE BLADDER Benjamin I. Joffe, John R. Christin, Clémentine Le Coz, Jamie S. Pak, Caroline Laplaca, Helena Vila Reyes, G. Joel DeCastro, Christopher B. Anderson, Cory Abate-Shen, James M. McKiernan, and Andrew T. Lenis Benjamin I. JoffeBenjamin I. Joffe , John R. ChristinJohn R. Christin , Clémentine Le CozClémentine Le Coz , Jamie S. PakJamie S. Pak , Caroline LaplacaCaroline Laplaca , Helena Vila ReyesHelena Vila Reyes , G. Joel DeCastroG. Joel DeCastro , Christopher B. AndersonChristopher B. Anderson , Cory Abate-ShenCory Abate-Shen , James M. McKiernanJames M. McKiernan , and Andrew T. LenisAndrew T. Lenis View All Author Informationhttps://doi.org/10.1097/01.JU.0001008640.01272.9d.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bacillus Calmette-Guérin (BCG) is standard of care for high-risk non-muscle invasive bladder cancer (NMIBC). However, approximately 40% of patients treated with BCG will experience treatment failure and recurrence. While the standard for patients for whom BCG fails is radical cystectomy (RC), many patients either refuse or are medically unfit for major surgery. We offered a regimen of docetaxel, gemcitabine, and cisplatin (DGC) for this highly-pretreated cohort of patients. METHODS: This was a retrospective review of all patients who received DGC from January 2018 to July 2023. This regimen included a 6-week induction of separate-day weekly docetaxel (80 mg), weekly gemcitabine (1000 mg or 2000 mg), and biweekly cisplatin (100 mg). In patients with treatment response, a maintenance regimen of separate-day monthly docetaxel (80 mg) and monthly gemcitabine (1000 mg) was initiated. Initial follow-up cystoscopy with biopsy was performed 6 weeks after the final instillation; follow-up cystoscopy and cytology were performed every 3 months. Complete response (CR) was defined as negative cystoscopy and cytology. Primary outcomes of interest were biopsy-proven recurrence, progression (increase in T stage), metastasis, and/or proceeding to RC. Pre- and post-DGC treatment tumors were sent for whole exome sequencing (WES). RESULTS: A total of 16 patients received DGC for NMIBC. Nearly 45% of patients had HGT1, 56% had concomitant carcinoma in situ, and 13% had variant histology. All patients were BCG unresponsive; 63% had another intravesical agent and 6% had systemic pembrolizumab prior to DGC. Full induction was completed in 13/16 patients (82%). At first follow-up, 7 patients (44%) had CR and maintenance therapy. Overall, patients were followed for median 41 months (IQR 12-49) after finishing induction; four patients (57%) recurred, of whom three underwent DGC reinduction with CR in one. By end of study period, 5/16 patients (31%) progressed, and 6/16 patients (37%) underwent RC. WES results are pending. CONCLUSIONS: In this highly-pretreated cohort of BCG-unresponsive NMIBC, most patients tolerated induction DGC. DGC resulted in a CR rate of nearly 45% and approximately two thirds of patients avoided radical cystectomy over the study period. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e247 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Benjamin I. Joffe More articles by this author John R. Christin More articles by this author Clémentine Le Coz More articles by this author Jamie S. Pak More articles by this author Caroline Laplaca More articles by this author Helena Vila Reyes More articles by this author G. Joel DeCastro More articles by this author Christopher B. Anderson More articles by this author Cory Abate-Shen More articles by this author James M. McKiernan More articles by this author Andrew T. Lenis More articles by this author Expand All Advertisement PDF downloadLoading ...