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Alternative to BCG Therapy – Gemcitabine and Docetaxel As an Effective NMIBC Treatment

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Alternative to BCG Therapy – Gemcitabine and Docetaxel As an Effective NMIBC Treatment

BCG is one of the most effective cancer treatments, but some people with non-muscle invasive bladder cancer don’t respond well to it. Therefore, many doctors have turned to other therapies instead.

According to new research from the University of Iowa, gemcitabine and docetaxel as an alternative treatment for NMIBC is an effective approach. Patients who had failed their first-line treatment with Bacillus Calmette-Guerin were found to benefit from taking gem/doce, helping them live longer without needing a new medication.

This study of the largest group of BCG-naive NMIBC patients to date demonstrated that combination therapy with gemcitabine and docetaxel led to a remission rate exceeding 50%. Furthermore, there was significantly lower toxicity and improved disease-free survival compared to using either drug alone.

This study, published in the Journal of Urology, is one of the most comprehensive to date regarding gem/doce as a possible replacement for BCG. According to Dr. Packiam from the University of Iowa Department of Urology who led this trial, “this research will be instrumental for physicians and patients worldwide as we fight against NMIBC.”

Intravesical BCG and other chemotherapy alternatives for NMIBC may be difficult to implement in low- and middle-income countries due to limited supply and lack of specialized pharmacies. Furthermore, lack of access to timely drugs may make it impossible to adhere to a regimen.

Additionally, the toxicities of chemotherapy drugs can pose additional challenges. In some cases, this may necessitate a different and more aggressive treatment than expected.

For this reason, UI Holden Comprehensive Cancer Center has developed an alternative to intravesical BCG immunotherapy: a combination of gemcitabine and docetaxel (gem/doce). This regimen can serve as the primary therapy for those who have failed first-line BCG treatments.

For over a decade, the University of Utah team has been using this combination with impressive results – typically one-year cancer free rates above 20%. Unfortunately, the cost to acquire gem/doce can be prohibitive for low-income patients, especially when considering its potential side effects.

High-risk NMIBC has an extremely high recurrence rate, with 70% experiencing at least one recurrence. Furthermore, these patients have a greater chance of developing advanced or metastatic disease than other patients. Transurethral resection of bladder tumors–which preserves the bladder without surgery–is thus an ideal treatment option for this type of cancer. Furthermore, successful resection can slow its progression and eliminate future surgical interventions.

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