Multi-Institution Evaluation of Sequential Gemcitabine and Docetaxel as Rescue Therapy for Nonmuscle Invasive Bladder Cancer
Multi-Institution Evaluation of Sequential Gemcitabine and Docetaxel as Rescue Therapy for Nonmuscle Invasive Bladder Cancer
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DOI：
10.1097/ju.0000000000000688
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发表时间：
2020-05-01
影响因子：
6.6
通讯作者：
O'Donnell, Michael A.
中科院分区：
文献类型：
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作者：
Steinberg, Ryan L.;Thomas, Lewis J.;O'Donnell, Michael A.
目的：卡介苗- guerin失活的非肌肉浸润性膀胱癌患者的膀胱内抢救治疗仍然是正在进行的研究的关键焦点。在2个回顾性的单机构队列中，连续膀胱内注射吉西他滨和多西他赛治疗显示出安全性和有效性。此后，这种双排衣已被多家机构采用作为膀胱内抢救的选择。我们报告了吉西他滨和多西他赛的多机构评估结果。材料和方法：各机构回顾性回顾了2009年6月至2018年5月期间膀胱内注射吉西他滨和多西他赛治疗非肌性浸润性膀胱癌的所有患者记录。只有复发性非肌性浸润性膀胱癌患者和有卡介苗治疗史的患者被纳入分析。如果患者在诱导后无疾病，维持由治疗医师决定。治疗后监测遵循美国泌尿学会指南。采用Kaplan-Meier法进行生存分析，采用Cox回归模型评估治疗失败的危险因素。结果：276例患者（中位年龄73岁，中位随访22.9个月）接受了治疗。9例患者不能耐受完整的诱导疗程。1年和2年无复发生存率分别为60%和46%，高分级无复发生存率分别为65%和52%。10例（3.6%）经尿道切除后出现疾病进展。43例患者（15.6%）接受膀胱切除术（诱导后中位11.3个月），其中11例（4.0%）进展为肌肉侵犯。分析未发现患者、疾病或既往治疗相关因素与吉西他滨和多西他赛失败相关。结论：膀胱内吉西他滨联合多西他赛治疗对复发性非肌肉浸润性膀胱癌患者卡介苗- guerin治疗后具有良好的耐受性和有效性。进一步的前瞻性研究是必要的。
Purpose:Rescue intravesical therapies for patients with bacillus Calmette-Guerin failure nonmuscle invasive bladder cancer remain a critical focus of ongoing research. Sequential intravesical gemcitabine and docetaxel therapy has shown safety and efficacy in 2 retrospective, single institution cohorts. This doublet has since been adopted as an intravesical salvage option at multiple institutions. We report the results of a multi-institutional evaluation of gemcitabine and docetaxel.Materials and Methods:Each institution retrospectively reviewed all records of patients treated with intravesical gemcitabine and docetaxel for nonmuscle invasive bladder cancer between June 2009 and May 2018. Only patients with recurrent nonmuscle invasive bladder cancer and a history of bacillus Calmette-Guerin treatment were included in the analysis. If patients were disease-free after induction, maintenance was instituted at the treating physician's discretion. Posttreatment surveillance followed American Urological Association guidelines. Survival analysis was performed using the Kaplan-Meier method and risk factors for treatment failure were assessed with Cox regression models.Results:Overall 276 patients (median age 73 years, median followup 22.9 months) received treatment. Nine patients were unable to tolerate a full induction course. One and 2-year recurrence-free survival rates were 60% and 46%, and high grade recurrence-free survival rates were 65% and 52%, respectively. Ten patients (3.6%) had disease progression on transurethral resection. Forty-three patients (15.6%) went on to cystectomy (median 11.3 months from induction), of whom 11 (4.0%) had progression to muscle invasion. Analysis identified no patient, disease or prior treatment related factors associated with gemcitabine and docetaxel failure.Conclusions:Intravesical gemcitabine and docetaxel therapy is well tolerated and effective, providing a durable response in patients with recurrent nonmuscle invasive bladder cancer after bacillus Calmette-Guerin therapy. Further prospective study is warranted.