Intravesical Gemcitabine for High Risk, Nonmuscle Invasive Bladder Cancer after Bacillus Calmette-Guerin Treatment Failure

Purpose: We report our experience with intravesical gemcitabine for bladder cancer after failed bacillus Calmette-Guerin treatment. Materials and Methods: We retrospectively reviewed the records of patients at our cancer center treated with intravesical gemcitabine after bacillus Calmette-Guerin failure. We estimated progression-free, recurrence-free and cancer specific survival using the cumulative incidence function, considering death from another cause as a competing risk. Comparisons were made using the Gray test. Overall survival was estimated using the Kaplan-Meier method and differences were compared with the log rank test. Results: Of 69 patients treated with intravesical gemcitabine 37 had bacillus Calmette-Guerin refractory disease. Median followup in progression-free patients was 3.3 years. Progression-free and cancer specific survival were similar in patients with refractory disease and those with other types of bacillus Calmette-Guerin failure. Overall survival was lower in patients with refractory disease (58% vs 71%) but this was not statistically significant (p = 0.096). Of the patients 27 patients experienced a complete response. Progression-free, cancer specific and overall survival did not differ significantly between patients with and without a complete response. Cystectomy was subsequently performed in 20 patients. Those with a complete response had a delayed time to cystectomy and no muscle invasive bladder cancer at cystectomy. There were no serious adverse events and only a minority of patients discontinued treatment due to adverse events. Conclusions: In our experience intravesical gemcitabine should be considered after bacillus Calmette-Guerin failure in patients with bladder cancer who refuse radical cystectomy or who are not candidates for major surgery.