Docetaxel, valrubicin do well as rescue treatment for recurrent nonmuscle-invasive bladder cancer

Sequential intravesical valrubicin and docetaxel prove to be an effective salvage treatment for patients with recurrent nonmuscle-invasive bladder cancer (NMIBC), a study has shown.

A team of investigators retrospectively identified patients with recurrent NMIBC who were treated with valrubicin and docetaxel between April 2013 and June 2021. Patients were administered weekly sequential intravesical instillation of valrubicin 800 mg and docetaxel 37.5 mg for 6 weeks. Monthly maintenance of 2 years was initiated if a patient was disease-free at first follow-up.

Finally, the investigators assessed recurrence-free survival, the primary outcome, using the Kaplan-Meier method.

Seventy-five patients were included in the analysis, with a median follow-up of 21 months. At 2 years, 12 patients with low-grade disease achieved a 73-percent recurrence-free survival, while 63 with recurrent high-grade disease achieved a 38-percent high-grade recurrence-free survival.

More than half of the patients (n=42, 56 percent) had carcinoma in situ present, but recurrence-free survival was similar between those with and without carcinoma in situ (p=0.63).

Two patients succumbed to metastatic bladder cancer, while 10 underwent cystectomy. Overall, cancer-specific, and cystectomy-free survival rates among those with high-grade disease were 87 percent, 96 percent, and 84 percent at 2 years, respectively.

Bladder spasms (n=18) were the most common adverse events, followed by urinary frequency (n=10) and dysuria (n=8). Of note, valrubicin and docetaxel induction was not well tolerated in two patients.

“In a heavily pretreated population, our results suggest valrubicin and docetaxel is an effective rescue treatment for patients with recurrent NMIBC,” the investigators said. “Further prospective evaluation is needed.”