Post-TURBT Gemcitabine Use Increased After Trial Results Published

Use of intravesical gemcitabine after surgery for low-grade bladder cancer increased following publication in May 2018 of a randomized clinical trial (RCT) demonstrating the efficacy of this treatment, according to a recent cross-sectional study.

Overall use of intravesical chemotherapy, however, did not increase since the study was published.

In a JAMA Network Open research letter, investigators concluded that “the findings of this cross-sectional study highlight the power as well as the limitations of prominent RCTs.”

Using data from the Premier Healthcare Databases, a large, all-payer sample capturing 84,994 index transurethral resections of bladder tumor (TURBTs), Patrick Lewicki, MD, of New York-Presbyterian Hospital, Weill Cornell Medicine in New York, New York, and colleagues examined the effect of the Southwestern Oncology Group (SWOG) SO337 RCT. Investigators in the trial cited as advantages the lower cost, wider availability, and milder toxicity of intravesical gemcitabine compared with mitomycin C.

Following publication of SWOG SO337, up to 5.3% of patients undergoing TURBT received intravesical chemotherapy in March 2020 compared with 0.1% before publication, Dr Lewicki and colleagues reported.

“In this cross-sectional study, we found that overall use of any post-TURBT chemotherapy did not increase in the 22 months since the publication of the SWOG SO337 RCT that our study covered, although use of post-TURBT gemcitabine did increase,” the authors wrote. “Future directions may benefit from attention to specific physician and patient factors leading to treatment omission.”

References

Lewicki P, Basourakos SP, Arenas-Gallo C, et al. Use of intravesical chemotherapy in the US following publication of a randomized clinical trial. JAMA Netw Open. Published online March 1, 2022. doi:10.1001/jamanetwworkopen.2022.0602

Messing EM, Tangen CM, Lerner SP, et al. Effect of intravesical instillation of gemcitabine vs saline immediately following resection of suspected low-grade non-muscle-invasive bladder cancer on tumor recurrence. SWOG SO337 randomized clinical trial. JAMA. 2018;319:1880-1888. doi:10.1001/jama.2018.4657

This article originally appeared on Renal and Urology News