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

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.