Efficacy and toxicity in scheduled intravesical gemcitabine versus Bacille Calmette-Guérin for Ta and T1 bladder cancer: a systematic review and meta-analysis.

Content Provider	Europe PMC
Author	Lu, Jun-Lin Xia, Qi-Dong Liu, Chen-Qian Sun, Jian-Xuan Yang, Yuan-Yuan Hu, Heng-Long Wang, Shao-Gang
Copyright Year	2021
Abstract	BackgroundWe conducted a meta-analysis to compare the efficacy and toxicity of scheduled intravesical gemcitabine (GEM) and Bacille Calmette-Guérin (BCG) for Ta and T1 non-muscle invasive bladder cancer (NMIBC).MethodsThe database search was performed in Ovid Medline, Embase, Web of Science, Cochrane Library from the commencement of the database to July 7, 2020. Trials using immediate instillation were excluded and we present the included studies in accordance with the PRISMA 2020 reporting checklist. The data extracted was analyzed using Stata 11.0 software.ResultsSix studies of 466 patients comparing GEM and BCG were finally included. No significant difference was detected between GEM and BCG group in recurrence free survival [hazard ratio (HR) =0.80, 95% confidence interval (95% CI), 0.46–1.37, P=0.410], progression free survival (HR =0.82, 95% CI, 0.38–1.77, P=0.621), and total adverse events [odds ratio (OR) =0.70, 95% CI, 0.38–1.29, P=0.253). However, patients receiving GEM treatment are less likely to develop urinary adverse events, such as dysuria (OR =0.50, 95% CI, 0.29–0.87) and hematuria (OR =0.40, 95% CI, 0.18–0.91). We performed subgroup analysis and found that the effects of GEM and BCG were similar even on patients with high recurrence risk tumor. Sensitivity analysis showed the robustness of the results.DiscussionScheduled intravesical GEM instillation has a similar effect with BCG instillation in preventing NMIBC recurrence and progression, but GEM therapy causes a lower incidence of dysuria and hematuria than BCG. GEM may be an alternative therapy for BCG. However, the results should be treated with caution due to the low to moderate quality of the included studies.
ISSN	2218676X
Journal	Translational Cancer Research
Volume Number	10
PubMed Central reference number	PMC8797991
Issue Number	6
PubMed reference number	35116595
e-ISSN	22196803
DOI	10.21037/tcr-21-291
Language	English
Publisher	AME Publishing Company
Publisher Date	2021-06-01
Access Restriction	Open
Rights License	Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/. 2021 Translational Cancer Research. All rights reserved.
Subject Keyword	Gemcitabine Bacille Calmette-Guérin (BCG) non-muscle invasive bladder cancer (NMIBC) meta-analysis tumor recurrence
Content Type	Text
Resource Type	Article
Subject	Radiology, Nuclear Medicine and Imaging Cancer Research Oncology