Long-term survival outcomes with intravesical docetaxel in the management of recurrent non-muscle-invasive bladder cancer (NMIBC) after previous BCG therapy
Barlow LJ, McKiernan JM, Benson MC. J Urol. 2012 Oct 30. pii: S0022-5347(12)05356-6. doi: 10.1016/j.juro.2012.10.068. [Epub ahead of print]

Source

Department of Urology, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York. Electronic address: ljb2119@columbia.edu.

Abstract

PURPOSE:

Docetaxel has been shown to be a safe agent for intravesical therapy. The addition of monthly maintenance treatments can extend the durability of response. We now report our cumulative experience with intravesical docetaxel in a larger cohort with extended follow-up.

MATERIALS AND METHODS:

54 patients received salvage intravesical docetaxel for BCG-refractory NMIBC between 2003 and 2012, including 18 patients treated during the original phase I trial. All patients were treated with 6 weekly instillations of intravesical docetaxel. Following the phase I trial, patients with a complete response to induction treatment were offered single-dose monthly maintenance treatments for a total of up to 12 months of docetaxel therapy. Recurrence was defined as positive biopsy or urine cytology. Recurrence-free survival, disease-specific survival, and overall survival were determined using Kaplan-Meier analyses.

RESULTS:

Median follow-up was 39.1 months. 32/54 patients (59%) had a complete initial response after induction therapy. 18/32 patients with a complete initial response received additional monthly maintenance treatments. The median time to recurrence in initial responders treated with and without docetaxel maintenance was 39.3 and 19.0 months, respectively. 1 and 3-year recurrence-free survival rates for the entire cohort were 40% and 25%, respectively. 17/54 patients (24%) underwent radical cystectomy after a median of 24 months of follow-up. 5-year disease-specific and overall survival rates were 85% and 71%, respectively.

CONCLUSIONS:

Intravesical docetaxel appears to be a promising agent with significant efficacy and durability for the management of BCG-refractory NMIBC. The addition of maintenance treatments may increase the duration of recurrence-free survival.