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Dr. Steinberg on next steps for gem-doce in upper tract carcinoma in situ


"There's definitely more work to do to confirm these results on a multi-institutional aspect," says Ryan L. Steinberg, MD.

In this video, Ryan L. Steinberg, MD, discusses next steps following the Urologic Oncology paper “Sequential endoluminal gemcitabine and docetaxel vs. Bacillus Calmette–Guérin for the treatment of upper tract carcinoma in situ.” Steinberg is a clinical assistant professor of urology at the University of Iowa in Iowa City.


Were there any notable differences observed regarding adverse events or patient tolerability between the 2 treatment regimens?

No, it was pretty common that patients would report some level of adverse events. The vast majority of those were grades 1 and 2. And really, what we saw was a lot of dysuria or burning with urination, perhaps some flank pain, bladder spasms, things that were not specifically to script that are pretty common even with lower tract or intravesical therapy given for bladder cancer. We did have, unfortunately, a few high-grade adverse events that occurred, including a death that was related to a UTI or urosepsis. And so we know that infection in any kind of instillation, regardless of whether it's a chemotherapy regimen or BCG, does place these patients at an increased risk for infectious sequelae. It's something that would need to be considered in anybody who we're to think about using any of these regimens in a nephron-sparing kind of matter.

What are the next steps for investigating gem-doce as a potential treatment option in this space?

A multi-institutional randomized trial would be the gold standard to make the comparison. Even a multi-institutional observational cohort would be beneficial; data collected in a prospective fashion. There's definitely more work to do to confirm these results on a multi-institutional aspect. The other thing that is very exciting is the use of things like Jelmyto for low-grade upper tract urothelial cell carcinoma, and potentially, there being ways to incorporate these types of agents into hydrogels or other delivery mechanisms may ultimately allow us to expand our regimen and to consider other ways of getting patients treated.

This transcription was edited for clarity.

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