Gemcitabine infusion therapy for non-muscle invasive bladder cancer Cao Ming, Department of Urology, Shanghai Renji Hospital The standard treatment for non-muscle invasive bladder cancer lies in transurethral tumor electrosurgery and postoperative bladder infusion therapy. For low-risk patients, commonly used perfusion drugs include chemotherapeutic agents such as epirubicin, mitomycin, and hydroxycamptothecin; for patients with intermediate to high-risk cancer, perfusion therapy with BCG is the first choice. Gemcitabine, as a novel chemotherapeutic agent, has shown good therapeutic effects in clinical settings with its intravenous chemotherapy regimen for muscle-infiltrating and metastatic bladder cancer. In recent years, the results of some clinical studies have shown the same efficacy of gemcitabine bladder perfusion for non-muscle-infiltrating bladder cancer [1]. Most current clinical trials have used gemcitabine instillation in patients in the intermediate to high-risk group, especially in cases where BCG bladder instillation has failed, for whom most physicians would recommend total cystectomy, but there is no recognized effective treatment for patients who wish to preserve the bladder or for whom surgery is not possible. a 2010 study published by Lorenzuo et al. in Cancer randomized controlled trial (N=80) in patients at high risk of recurrence after BCG infusion showed that, when comparing treatment with gemcitabine or BCG infusion, the gemcitabine group was more effective in reducing the rate of tumor recurrence (87.5%
Vs 52.5%; p=0.002), and improved 2-year recurrence-free survival rate (19% Vs
3%, p=0.008) were significantly better than the BCG group and were well tolerated [2]. And the results of a study reported by Addeo et al. in 2009 comparing gemcitabine with mitomycin showed that for patients who failed conventional perfusion chemotherapy, the rate of tumor-free survival was significantly higher in the gemcitabine perfusion than in the mitomycin group (N=108, p=0.0021), and the rate of adverse effects such as chemical cystitis was also lower in the gemcitabine group [3]. These findings suggest that gemcitabine has better prevention of recurrence compared to BCG and commonly used mitomycin in patients who have failed previous perfusion therapy. In contrast, in a clinical study reported by Korean scholars, the authors compared the efficacy of postoperative BCG alone and BCG gemcitabine combination in treating patients in the high-risk group for recurrence, and although the progression and recurrence rates were similar between the two groups, the combination group was significantly better than the BCG monotherapy group in terms of recurrence-free survival time (N=87, P=0.013), and the treatment side effects were similar [4]. In China, in a data set reported by Shanghai Renji Hospital, gemcitabine infusion was superior to conventional infusion chemotherapy such as mitomycin in terms of 2-year relapse-free survival and relapse-free survival time for cases that relapsed within 1 year of conventional infusion, and had a good safety profile [5]. Some clinical data are available to suggest that gemcitabine infusion chemotherapy is an alternative treatment option for non-muscle invasive bladder cancer in the high-risk group of recurrence, especially in patients who have failed BCG therapy, and does not increase adverse effects in patients, but its long-term efficacy in controlling tumor progression and after infusion therapy still lacks convincing clinical trial results. Considering the promising results shown by intravenous chemotherapy regimens with gemcitabine, we believe that gemcitabine infusion therapy is also a promising option for non-muscle invasive bladder cancer. References: 1. Shelley MD,Jones G.
Et al. Intravesical gemcitabine therapy for non-muscle invasive bladder cancer
(NMIBC): a systematic review. BJU Int. 2012; 109:496-505.2. Di Lorenzo G, Perdona S, Damiano R, et al. Gemcitabine
versus bacilli Calmette-Guerin after initial bacilli Calmette-Guerin failure in
non-muscle invasive bladder cancer: a multicenter prospective randomized trial.
Cancer. 2010; 116: 1893-1900.3. Addeo R, Caraglia M,Bellini S,
et al. Randomized phase III trial on gemcitabine versus mytomicin in recurrent
superficial bladder cancer: evaluation of efficacy and tolerance. j Clin Oncol.
2010; 28:543-548.4. Cho DY, Bae JH, Moon DG, et al. The effects
of intravesical chemoimmunotherapy with gemcitabine and Bacillus Calmette-Guérin
in superficial bladder cancer: a preliminary study. J Int Med Res. 2009;
37:1823-1830.5. Cao M, Chen HG et al. Study of postoperative perfusion of gemcitabine in recurrent superficial bladder tumors Chinese Journal of Oncology 2011, Vol. 6