Below is the summary of my Googling and reading some books to understand about gemcitabine and doxorubicin.
The take-home is as follows
1. Gemcitabine and doxorubicin kill cancer cells (also normal cells) in two different ways.
2. Gemcitabine and doxorubicin are tolerable.
3. When Gemcitabine is given first and followed by doxorubicin the efficacy is higher.
4. When heated Gemcitabine and heated doxorubicin, the efficacy is more higher.
5. A reduced dose of BCG (i.e. 1/3) gives similar efficacy to a full dose.
1. Gemcitabine prevents DNA replication of cells and leads the cells to die.
Doxorubicin prevents cells from dividing into two daughter cells and leas the cells to die.
2. The University of Iowa studied the efficacy of gemcitabine and doxorubicin when they were given sequentially.
Of 45 patients who were treated with gemcitabine and doxorubicin, treatment success (no recurrence and no
cystectomy) were 66% at first surveillance,54% at 1 year and 34% at 2 years.
3. The University of Arizona studied the efficacy of heated gemcitabine and doxorubicin when they were given
sequentially. The treatment was given to 60 patients who did not respond well to BCG treatment. Of 60 patients, treatment success was 83% at first surveillance, 69% at 1 year and 55 at 2 years.
4. Treatment tolerance of the study at the University of Arizona
Thirty-one patients (52%) reported experiencing adverse symptoms during their GEM/DOCE treatment course,
but only 10 of these patients had symptoms (i.e. UTI) that impacted the treatment schedule with short 1-week
delays. All the patients were still able to finish their treatment course. The most common side effects noted were
mild fatigue (20%), hematuria (20%), mild urinary frequency/urgency (13%), dysuria (10%), and nocturia (7%).
5. BCG shortage
The supply chain of BCG by MERCK is very opaque. Some institutions have it and some don't. Looking for
BCG at other institutions is a possibility, especially when Dr. Kamat of MD Anderson recommended 1/3 dose for
even initial 6 weeks BCG induction course backed by the study in Europe during BCG shortage.
References
The study by the University of Iowa
"Sequential Intravesical Gemcitabine and Docetaxel for the Salvage Treatment of Non-Muscle Invasive Bladder Cancer"
content.iospress.com/articles/bladder-cancer/blc0008
The study by the University of Arizona
"Salvage Hyperthermic Gemcitabine and Docetaxel Combination Chemotherapy After BCG Failure in Non-Muscle Invasive Bladder Cancer Patients " 2019
content.iospress.com/articles/bladder-cancer/blc190245?utm_source=TrendMD&utm_medium=cpc&utm_campaign=Bladder_Cancer_TrendMD_0
A panel discussion during American Urological Association virtual meetings July, 2020
"Filling the BCG Shortage Hole for Patients With NMIBC"
www.targetedonc.com/view/filling-the-bcg-shortage-hole-for-patients-with-nmibc