Thank you for detail description of the steps and side effects of gemcitabine and docetaxel instillation. The steps are very similar to what University of Iowa team had reported. Incidentally, I recognize the face of Dr. Joshua Meeks of Northwesten Memorial Hospital. I have seen him giving interviews in video. It turns out that he was speaking about gemcitabine and docetaxcel in one of video series of Urotoday. I have listed the link below.
As you mentioned, it is time consuming administration compared to intravesical chemotherapy with single agent.
In the video, Dr. Meeks also says it is time consuming and requires training among staff and because of it, the treatment is not often offered in smaller local hospitals. Dr. Meeks also mentions that gemcitabine and docetaxcel treatment is well tolerated and gives one of highest response rate compared to other treatment for BCG unresponsive bladder cancer. Another point he mentions is that our immune system is exhausted and tired
in dealing with BCG for long time and intravesical chemotherapy will an opportunity for the immune system to rest and recover. It is interesting thought.
www.urotoday.com/video-lectures/bladder-cancer/video/1622-greatest-advances-in-bcg-unresponsive-bladder-cancer-highlights-from-the-2019-suo-meeting-joshua-meeks.html