Multi-institutional analysis of sequential intravesical gemcitabine and mitomycin C chemotherapy for non–muscle invasive bladder cancer

• Published in: Urologic oncology 2014-01, Vol.32 (1), p.35.e15-35.e19
• Main Authors: Lightfoot, Andrew J., M.D, Breyer, Benjamin N., M.D, Rosevear, Henry M., M.D, Erickson, Bradley A., M.D., M.Sc, Konety, Badrinath R., M.D., M.B.A, O'Donnell, Michael A., M.D
• Format: Article
• Language: English
• Subjects: Academic Medical Centers; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Antineoplastic therapy; Bladder cancer; Chemotherapy protocols; Cystectomy - methods; Deoxycytidine - administration & dosage; Deoxycytidine - analogs & derivatives; Disease-Free Survival; Drug Administration Schedule; Female; Gemcitabine; Humans; Male; Middle Aged; Mitomycin; Mitomycin - administration & dosage; Recurrence; Retrospective Studies; Treatment Outcome; Urinary Bladder Neoplasms - drug therapy; Urology
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2013.01.009

Abstract Objective Apart from cystectomy, few treatment options exist for the management of bacillus Calmette-Guerin refractory non–muscle invasive bladder cancer (NMIBC). We report a multi-institutional experience with sequential intravesical combination chemotherapy using gemcitabine and mitomycin C (MMC) for NMIBC in the treatment of high-risk patients. Methods We performed a retrospective review of patients who received 6 weekly treatments with sequential intravesical gemcitabine (1 g) and MMC (40 mg) chemotherapy for NMIBC. Gemcitabine was administered first and retained for 90 minutes and then drained. MMC was then administered directly after and retained for an additional 90 minutes. Forty-seven patients received treatment from 3 academic tertiary referral centers between 2000 and 2010. Results Forty-seven patients (median age 70, range 32–85; 36 males, 11 females) who previously failed a median of 2 intravesical treatments were reviewed. Complete response, 1-year, and 2-year recurrence-free survival rates for all patients were 68%, 48%, and 38%, respectively. Median recurrence-free survival for all patients was 9 months (range 1–80). Fourteen of 47 patients (30%) remained free of recurrence with a median time to follow-up of 26 months (range 6–80 mo). Ten patients required cystectomy. Conclusion Sequential intravesical combination chemotherapy using gemcitabine and MMC appears to be a useful treatment for patients with high-grade NMIBC as well as those with prior bacillus Calmette-Guerin failure. Further prospective studies are warranted.