MP63-07 SEQUENTIAL ENDOLUMINAL DOXORUBICIN AND GEMCITABINE ALTERNATING WITH SEQUENTIAL MITOMYCIN AND DOCETAXEL FOR MULTI-FAILURE NON-MUSCLE INVASIVE UROTHELIAL CARCINOMA OF THE UPPER AND LOWER URINARY TRACTS

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP63-07 SEQUENTIAL ENDOLUMINAL DOXORUBICIN AND GEMCITABINE ALTERNATING WITH SEQUENTIAL MITOMYCIN AND DOCETAXEL FOR MULTI-FAILURE NON-MUSCLE INVASIVE UROTHELIAL CARCINOMA OF THE UPPER AND LOWER URINARY TRACTS Ian M. Mcelree, Ryan L. Steinberg, Sarah L., Vignesh T. Packiam, and Michael A. O'Donnell Ian M. McelreeIan M. Mcelree More articles by this author , Ryan L. SteinbergRyan L. Steinberg More articles by this author , Sarah L. Sarah L. More articles by this author , Vignesh T. PackiamVignesh T. Packiam More articles by this author , and Michael A. O'DonnellMichael A. O'Donnell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003321.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sequential intravesical gemcitabine and docetaxel (Gem/Doce) has shown over 50% 2-year high-grade (HG) recurrence free survival in patients with BCG-unresponsive non-muscle invasive urothelial carcinoma (NMIUC) of the bladder. For those who recur, further bladder-sparing therapies are needed, particularly when cystectomy is refused or precluded. We report outcomes of patients treated with a novel regimen of sequential doxorubicin and gemcitabine alternating with sequential mitomycin C and docetaxel (Quad Chemo) as a rescue therapy for patients with recurrent high-grade (HG) NMIUC. METHODS: We retrospectively reviewed 27 patients (37 treated units; 27 lower tract, and 10 upper tract) treated with Quad Chemo from December 2007 to February 2021. Patients received 8 induction endoluminal instillations of sequential 50 mg doxorubicin and 1 g gemcitabine alternating weekly with sequential 40 mg mitomycin C and 37.5 mg docetaxel. Alternating monthly maintenance treatment was administered up to 24 months if disease free at 3-month surveillance. The primary outcome was recurrence-free survival (RFS) defined as no disease on bladder/upper tract wash cytology or for-cause biopsies. Progression events included development of muscle-invasive or metastatic disease and any death due to bladder cancer. Adverse events were reported per CTCAE v.5. RESULTS: Median follow-up was 36 months. Patients with lower tract disease had a median of 3 prior inductions and upper tract 1 prior induction course. Stage at induction was pure CIS or positive cytology in 29 (78%) units, CIS+papillary in 5 (14%), and pure HG papillary in 1 (2.7%). Two (5.4%) upper tract units received Quad Chemo following a suspicious cytology. Among all treated units, the 2-year RFS rate was 38%. If disease-free at first follow-up, median duration of response was 30 months. The 2-year cystectomy-free, progression-free, and cancer-specific survival rates were 82%, 87%, and 96%, respectively. Regarding adverse events, 7.4% (2/27) of patients had a grade 3 event, including bladder stone development, bladder ulceration, and de-novo hydronephrosis. 67% (18/27) of patients experienced a grade 1-2 event. Induction treatment was ended in 11% (3/27) of patients due to side effects. CONCLUSIONS: Quad Chemo shows efficacy in a heavily pretreated HG NMIUC cohort but with a more severe side effect profile. Further prospective evaluation is needed for this regimen and to evaluate the boundaries of intravesical therapy. Source of Funding: This work was supported by the John & Carol Walter Family Foundation and the Cancer Center Support Grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e873 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ian M. Mcelree More articles by this author Ryan L. Steinberg More articles by this author Sarah L. More articles by this author Vignesh T. Packiam More articles by this author Michael A. O'Donnell More articles by this author Expand All Advertisement PDF downloadLoading ...