Comparation efficacy of intravesical instillation of Gemcitabine and Bacille Calmette-Guérin (BCG) in the treatment of patients with primary and recurrent high-grade non-muscle invasive bladder cancer

Abstract

Introduction: non-muscle invasive bladder cancer (NMIBC) has traditionally been managed with transurethral resection followed by intravesical chemotherapy and/or bacillus Calmette-Guerin (BCG) in a risk-adapted manner. The use of intravesical chemotherapy is increasingly widespread, with a favorable cost-benefit ratio.

Objective: To know the effectiveness of the use of gemcitabine as intravesical therapy in the management of patients with high risk and recurrent non-muscle invasive bladder cancer.

Methods: A theoretical review was carried out, a search in specialized databases was implemented through the PICOT strategy; through DeCS/ MeSH terms, in Pubmed, European Association of Urology, and search engines such as TripDatabase. Only clinical trials were selected, which were evaluated using CONSORT criteria.

Results: 621 articles were identified, 6 clinical trials were included, with 562 patients with non-muscle invasive bladder cancer (NMIBC). Intravesical gemcitabine, in monotherapy or combined with docetaxel, was associated with a lower rate of serious secondary events in patients with non-muscle invasive bladder cancer. The events were mild and consisted of hematuria, and lower urinary tract symptoms. Treatment response was similar to bacillus Calmette-Guerin (BCG), with of free referral, disease-free, survival rates of 12 to 24 months . It is considered a safe and efficient option compared to the use of bacillus Calmette-Guérin intravesical (BCG).

Conclusions: The intravesical gemcitabine is a safe and effective option in the treatment of patients with non-muscle invasive bladder cancer (NMIBC) who have not had an adequate response to the use of bacillus Calmette-Guerin  intravesical (BCG), with a low incidence of serious adverse events, and similar oncological results. More research is needed, with long-term follow-up