Sequential Intravesical Valrubicin and Docetaxel for the Salvage Treatment of Non–Muscle-Invasive Bladder Cancer. Issue 5 (5th November 2022)

• Record Type: Journal Article
• Authors: McElree, Ian M.; Packiam, Vignesh T.; Steinberg, Ryan L.; Mott, Sarah L.; Gellhaus, Paul T.; Nepple, Kenneth G.; O'Donnell, Michael A.
• Is Part Of: Journal of urology. Volume 208:Issue 5(2022)
• Page Start: 969
• Page End: 977
• Publication Date: 2022-11-05
• Subjects: urinary bladder neoplasms -- docetaxel -- valrubicin; Genitourinary organs -- Periodicals; Urology -- Periodicals; Urology -- Periodicals; Urologie -- Périodiques; Urologie; 616.6
• DOI: 10.1097/JU.0000000000002848
• Languages: English
• ISSNs: 0022-5347

Abstract

Abstract : Purpose: Intravesical gemcitabine-docetaxel has emerged as an efficacious and well-tolerated salvage therapy for non–muscle-invasive bladder cancer. However, further rescue therapies are needed for subsequent recurrences or intolerance, particularly when cystectomy is refused or precluded. Valrubicin is a U.S. Food and Drug Administration-approved agent for bacillus Calmette-Guérin unresponsive disease, yet as monotherapy has demonstrated poor efficacy. We report our experience with sequential intravesical valrubicin and docetaxel as a rescue therapy for non–muscle-invasive bladder cancer. Materials and Methods: We retrospectively identified all patients with recurrent non–muscle-invasive bladder cancer treated with valrubicin and docetaxel between April 2013 and June 2021. Patients received weekly sequential intravesical instillations of 800 mg valrubicin and 37.5 mg docetaxel for 6 weeks. If disease-free at first follow-up, monthly maintenance of 2 years was initiated. The primary outcome was recurrence-free survival, assessed using the Kaplan-Meier method. Results: The analysis included 75 patients with median follow-up of 21 months (IQR: 13-37). Twelve patients with low-grade disease had a 73% recurrence-free survival at 2 years. Sixty-three patients with recurrent high-grade disease had a 38% 2-year high-grade recurrence-free survival. Forty-two (56%) patients had carcinoma in situ present; recurrence-free survival was similar for those with and without carcinoma in situ ( P = .63). Two patients died of metastatic bladder cancer while 10 underwent cystectomy. Among patients with high-grade disease, overall, cancer-specific, and cystectomy-free survivals were 87%, 96%, and 84% at 2 years, respectively. Adverse events included bladder spasms (n = 18), urinary frequency (n = 10), and dysuria (n = 8). Two patients could not tolerate valrubicin and docetaxel induction. Conclusions: In a heavily pretreated population, our results suggest valrubicin and docetaxel is an effective rescue treatment for patients with recurrent non–muscle-invasive bladder cancer. Further prospective evaluation is needed.