For suspected low-grade, newly diagnosed, or occasionally recurrent bladder cancer, a single post-transurethral resection of bladder tumor (TURBT) instillation of gemcitabine (Gemzar) reduces bladder cancer recurrence by 47%.
The simple step is not only potentially life-saving; it’s safe, well-tolerated, readily available, and much cheaper than mitomycin, according to Edward M. Messing, MD, of the University of Rochester School of Medicine and Dentistry, Rochester, NY.
Dr. Messing, an investigator with SWOG, the international clinical trials network funded by the National Cancer Institute, presented findings from a phase III blinded clinical trial during the AUA annual meeting in Boston.
The post-TURBT standard of care has been to use mitomycin C, but few patients received it—in part because of shortages of this medication, symptomatic side effects with its use, and, currently, its expense, according to Dr. Messing.
“Urologists in Europe and Canada have been doing this procedure for more than 20 years with other chemotherapy drugs, with the research to prove it. Even the AUA recommends immediate post-TURBT intravesical instillation of chemotherapy. Now that we’ve got results from an American study, using a readily available drug that is very well tolerated, maybe American urologists will start using gemcitabine this way. I certainly hope this finally changes our standard of care,” he said.
Dr. Messing and colleagues enrolled 406 patients with non-muscle invasive bladder cancer and followed them for 4 years. In one group, post-TURBT subjects received a single 3.5-ounce instillation of gemcitabine, administered right after surgery and allowed to sit in the bladder for 1 hour. The other group received an infusion of saline only, post TURBT.