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Phase II Trial of Intravesical Gemcitabine in Bacille Calmette-Guérin–Refractory Transitional Cell Carcinoma of the Bladder

Guido Dalbagni, Paul Russo, Bernard Bochner, Leah Ben-Porat, Joel Sheinfeld, Pramod Sogani, Machelle S. Donat, Harry W. Herr, Dean Bajorin

From the Department of Urology, Division of Epidemiology and Biostatistics, the Genitourinary Oncology Service, Division of Solid Tumor Oncology, and the Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY

Address reprint requests to Guido Dalbagni, MD, Department of Urology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, C-1168, New York, NY 10021; e-mail: dalbagng{at}mskcc.org

PURPOSE: The aim of this phase II study was to determine the efficacy of gemcitabine administered as an intravesical agent in patients with bacille Calmette-Guérin (BCG) –refractory transitional cell carcinoma of the bladder.

PATIENTS AND METHODS: Patients with superficial bladder cancer refractory or intolerant to intravesical BCG therapy and refusing a cystectomy were considered eligible for the trial. Eligible patients received two courses of intravesical gemcitabine twice weekly at a dose of 2,000 mg/100 mL for 3 consecutive weeks, with each course separated by 1 week of rest. Patients were evaluated for response at 8 weeks, then every 3 months to 1 year.

RESULTS: Thirty eligible patients were included on study. The median follow-up for all the patients was 19 months (range, 0 to 35 months). Of the 30 patients, 15 (50%; 95% CI, 32% to 68%) achieved a complete response (CR). Twelve patients had tumor recurrence with a median recurrence-free survival time of 3.6 months (95% CI, 2.9 to 11.0 months). Two patients maintained a CR at 23 and 29 months, respectively. The 1-year recurrence-free survival rate for patients with a CR was 21% (95% CI, 0% to 43%). Two patients progressed to a higher stage while receiving gemcitabine treatment. The median follow-up for patients who did not have a progression or a cystectomy was 19 months (range, 2 to 35 months). Eleven patients (37%) underwent a cystectomy subsequent to gemcitabine therapy.

CONCLUSION: Gemcitabine has activity in a high-risk patient population and remains a viable option for some patients who refuse cystectomy.

Supported by Eli Lilly and Co.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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