Gemcitabine-docetaxel without BCG: 80% free of high-grade recurrence at three years

The edition in brief

Updated three-year results of a single-arm phase 2 trial, published in June, gave intravesical gemcitabine and docetaxel instead of BCG to 25 patients with BCG-naive high-risk non-muscle-invasive bladder cancer. High-grade recurrence-free survival was 84% at two years and 80% at three, with no progression on treatment and two cystectomies; a fifth had a grade 3 adverse event. It is too small to replace BCG but supports the regimen where BCG is unavailable. In 267,133 US veterans with new microhaematuria, only 11.9% had cystoscopy within two years and 1.5% were diagnosed with bladder cancer; age, male sex, smoking and 25 or more red cells per high-power field carried most of the risk, and a simple model outperformed the AUA risk categories. Post hoc analyses of ARASENS and LATITUDE found testosterone above 35 ng/dL during intensified therapy linked to worse survival with abiraterone (HR 1.49) but not significantly with darolutamide-docetaxel. In the LURN cohorts, urgency incontinence was associated with vascular disease and erectile dysfunction. The pearl covers tamsulosin and cataract surgery.