Abstract
Background: Bladder cancer is the most common type of cancer in the urinary system and the eleventh most common cancer in the world. The overall 5-year survival of bladder cancer in metastatic stage is very low. The standard first-line chemotherapy for bladder cancer is M-VAC (methotrexate, vinblastine, doxorubicin, cisplatin) and GC (gemcitabine, cisplatin) while the second-line is vinflunine. Gemcitabine has shown a higher response rate than vinflunine as a second-line treatment. But, the overall survival-rate of gemcitabine is still unknown. Objective: To determine whether gemcitabine monotherapy can increase the survival rate in metastatic bladder carcinoma after prior platinum-based chemotherapy. Methods: A literature search was through 3 databases: Pubmed, Scopus, and Cochrane. Studies were selected based on PICO and eligibility criteria for this report. Four studies from 3 databases were selected and critically appraised using Oxford University’s Center of Evidence-Based Medicine (CEBM) form. Result: Gemcitabine monotherapy may increase the survival rate of metastatic bladder cancer patients. However, gemcitabine has several severe side effects and the validity of the studies is low. Conclusion: Gemcitabine monotherapy may increase the survival rate of metastatic bladder cancer patients, but the evidence level is low.
 
 Latar belakang: Kanker kandung kemih merupakan kanker sistem saluran kemih yang paling umum dan merupakan kanker paling umum kesebelas di dunia. Kesintasan 5 tahun kanker kandung kemih cukup tinggi, namun sangat rendah pada kondisi metastasis. Kemoterapi standar lini pertama untuk kanker kandung kemih adalah M-VAC (methotrexate, vinblastine, doxorubicin, cisplatin) dan GC (gemcitabine, cisplatin), sedangkan lini kedua adalah vinflunine. Gemcitabine sebagai pengobatan lini kedua telah menunjukkan tingkat respons lebih tinggi daripada vinflunine. Namun, kesintasan monoterapi gemcitabine sebagai terapi lini kedua setelah kemoterapi berbasis platinum secara keseluruhan masih belum diketahui. Tujuan: Mengetahui apakah monoterapi gemcitabine sebagai terapi lini kedua setelah kemoterapi berbasis platinum dapat meningkatkan tingkat kelangsungan hidup pasien kanker kandung kemih yang metastatik. Metode: Pencarian literatur menggunakan 3 database, yaitu Pubmed, Scopus, dan Cochrane. Studi dipilih berdasarkan PICO dan kriteria kelayakan yang sesuai untuk laporan ini. Empat studi terpilih dinilai secara kritis menggunakan formulir center of evidence based medicine dari Universitas Oxford. Hasil: Monoterapi gemcitabine dapat meningkatkan angka kelangsungan hidup pasien kanker kandung kemih yang mengalami metastasis. Namun, gemcitabine memiliki beberapa efek samping berat dan validitas penelitian rendah. Simpulan: Monoterapi gemcitabine dapat meningkatkan tingkat kelangsungan hidup pada pasien kanker kandung kemih metastatik, namun level of evidence rendah. 
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