MP16-18: COMBINATION REGIMEN OF INTRAVESICAL DOCETAXEL, GEMCITABINE, AND CISPLATIN IN PATIENTS WITH BCG-UNRESPONSIVE NON-MUSCLE INVASIVE UROTHELIAL CARCINOMA OF THE BLADDER
Friday, May 3, 2024 1:00 PM to 3:00 PM · 2 hr. (US/Central)
221B
Abstract
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Full Abstract and Figures
Author Block
Benjamin I Joffe*, John R Christin, Clémentine Le Coz, Jamie S Pak, Caroline Laplaca, Helena Vila Reyes, G. Joel DeCastro, Christopher B Anderson, Cory Abate-Shen, James M McKiernan, Andrew T Lenis, New York, NY
Introduction
Bacillus Calmette-Guérin (BCG) is standard of care for high-risk non-muscle invasive bladder cancer (NMIBC). However, approximately 40% of patients treated with BCG will experience treatment failure and recurrence. While the standard for patients for whom BCG fails is radical cystectomy (RC), many patients either refuse or are medically unfit for major surgery. We offered a regimen of docetaxel, gemcitabine, and cisplatin (DGC) for this highly-pretreated cohort of patients.
Methods
This was a retrospective review of all patients who received DGC from January 2018 to July 2023. This regimen included a 6-week induction of separate-day weekly docetaxel (80mg), weekly gemcitabine (1000mg or 2000mg), and biweekly cisplatin (100mg). In patients with treatment response, a maintenance regimen of separate-day monthly docetaxel (80mg) and monthly gemcitabine (1000mg) was initiated. Initial follow-up cystoscopy with biopsy was performed 6 weeks after the final instillation; follow-up cystoscopy and cytology were performed every 3 months. Complete response (CR) was defined as negative cystoscopy and cytology. Primary outcomes of interest were biopsy-proven recurrence, progression (increase in T stage), metastasis, and/or proceeding to RC. Pre- and post-DGC treatment tumors were sent for whole exome sequencing (WES).
Results
A total of 16 patients received DGC for NMIBC. Nearly 45% of patients had HGT1, 56% had concomitant carcinoma in situ, and 13% had variant histology. All patients were BCG unresponsive; 63% had another intravesical agent and 6% had systemic pembrolizumab prior to DGC. Full induction was completed in 13/16 patients (82%). At first follow-up, 7 patients (44%) had CR and maintenance therapy. Overall, patients were followed for median 41 months (IQR 12-49) after finishing induction; four patients (57%) recurred, of whom three underwent DGC reinduction with CR in one. By end of study period, 5/16 patients (31%) progressed, and 6/16 patients (37%) underwent RC. WES results are pending.
Conclusions
In this highly-pretreated cohort of BCG-unresponsive NMIBC, most patients tolerated induction DGC. DGC resulted in a CR rate of nearly 45% and approximately two thirds of patients avoided radical cystectomy over the study period.
Source Of Funding
N/A
Author Block
Benjamin I Joffe*, John R Christin, Clémentine Le Coz, Jamie S Pak, Caroline Laplaca, Helena Vila Reyes, G. Joel DeCastro, Christopher B Anderson, Cory Abate-Shen, James M McKiernan, Andrew T Lenis, New York, NY
Introduction
Bacillus Calmette-Guérin (BCG) is standard of care for high-risk non-muscle invasive bladder cancer (NMIBC). However, approximately 40% of patients treated with BCG will experience treatment failure and recurrence. While the standard for patients for whom BCG fails is radical cystectomy (RC), many patients either refuse or are medically unfit for major surgery. We offered a regimen of docetaxel, gemcitabine, and cisplatin (DGC) for this highly-pretreated cohort of patients.
Methods
This was a retrospective review of all patients who received DGC from January 2018 to July 2023. This regimen included a 6-week induction of separate-day weekly docetaxel (80mg), weekly gemcitabine (1000mg or 2000mg), and biweekly cisplatin (100mg). In patients with treatment response, a maintenance regimen of separate-day monthly docetaxel (80mg) and monthly gemcitabine (1000mg) was initiated. Initial follow-up cystoscopy with biopsy was performed 6 weeks after the final instillation; follow-up cystoscopy and cytology were performed every 3 months. Complete response (CR) was defined as negative cystoscopy and cytology. Primary outcomes of interest were biopsy-proven recurrence, progression (increase in T stage), metastasis, and/or proceeding to RC. Pre- and post-DGC treatment tumors were sent for whole exome sequencing (WES).
Results
A total of 16 patients received DGC for NMIBC. Nearly 45% of patients had HGT1, 56% had concomitant carcinoma in situ, and 13% had variant histology. All patients were BCG unresponsive; 63% had another intravesical agent and 6% had systemic pembrolizumab prior to DGC. Full induction was completed in 13/16 patients (82%). At first follow-up, 7 patients (44%) had CR and maintenance therapy. Overall, patients were followed for median 41 months (IQR 12-49) after finishing induction; four patients (57%) recurred, of whom three underwent DGC reinduction with CR in one. By end of study period, 5/16 patients (31%) progressed, and 6/16 patients (37%) underwent RC. WES results are pending.
Conclusions
In this highly-pretreated cohort of BCG-unresponsive NMIBC, most patients tolerated induction DGC. DGC resulted in a CR rate of nearly 45% and approximately two thirds of patients avoided radical cystectomy over the study period.
Source Of Funding
N/A