Intravesical gemcitabine: an update of clinical results.
OBJECTIVE
Nonmuscle-invasive bladder cancer is a common malignancy, standardly treated by transurethral resection and adjuvant intravesical instillations of chemotherapy or immunotherapy. Adjuvant instillations are needed to reduce recurrence and/or progression. With currently existing adjuvant treatments, however, recurrences still occur, progression is hardly influenced and these treatments induce local or systemic side effects. In search for efficacy improvement and side effect reduction, we reviewed the promising properties of the relatively new intravesical drug, gemcitabine.


RESULTS
The safety of gemcitabine is tested in different instillation schemes, drug concentrations and administered volumes. Its safety profile is excellent, with good tolerability and minimal toxicity up to 2000 mg/50 ml for 2-h instillations. In comparison with other drugs, the ablative efficacy of gemcitabine is good. The first studies on prophylactic efficacy in intermediate-risk, high-risk and bacillus Calmette-Guerin-refractory patients are promising but limited by the small number of patients studied.


CONCLUSIONS
The available literature underlines the promising properties of gemcitabine for the intravesical use against nonmuscle-invasive bladder cancer. Exploring phase-II and comparative randomized phase-III studies should provide additional information on gemcitabine and its benefit to clinical practice.
Hendricksen
Kees
K
Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Witjes
J Alfred
JA
D000283:Administration, Intravesical; D000818:Animals; D000964:Antimetabolites, Antineoplastic / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use; D018450:Disease Progression; D006801:Humans; D012008:Recurrence; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy*; D000093542:Gemcitabine
D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine