Intravesical gemcitabine and docetaxel vs. re-induction Bacillus Calmette Guerin as first-line salvage therapy for non-muscle invasive bladder cancer.

Abstract

Objectives: To compare the outcomes between re-induction Bacillus Calmette-Guérin (BCG) and sequential intravesical gemcitabine-docetaxel (Gem/Doce) therapy in patients with high-grade (HG) non-muscle invasive bladder cancer (NMIBC) following failure of initial induction BCG.

Materials and methods: We retrospectively identified patients who received induction BCG therapy between 2017 and 2023. Inclusion criteria were high-grade NMIBC recurrence post-BCG induction, with subsequent treatment by either re-induction BCG or Gem/Doce.

Results: From 2017 to 2023, 140 patients received induction BCG, with 30 (21.4%) showing persistent HG NMIBC. Of these, five (16.7%) were treated with re-induction BCG and 11 (36.7%) with Gem/Doce. In the re-induction BCG group, four patients (80%) had HGTa and one (20%) had HGT1. In the Gem/Doce group, eight patients (73%) had HGTa, two (18%) had HGT1 and one (9%) had carcinoma in situ (CIS). Initial post-treatment cystoscopy showed recurrence in one re-induction BCG patient (20%) with HGT1 and CIS and in two Gem/Doce patients (18%) with HGTa. No adverse events were reported with Gem/Doce.

Conclusion: Our initial experience with intravesical Gem/Doce suggests that it is better tolerated, with fewer adverse events and comparable recurrence rates at three months, compared to re-induction BCG in patients with BCG-failure NMIBC.