First of all, your other post indicates that the treatment was switched to Gemcitabine from BCG after two years because the side effect was getting too much for you. I did not see that you had a recurrence during the two years.
So, it is possible that you had been cured already by the BCG treatment you had already. You did not have a recurrence during the BCG treatment. So, I see that BCG treatment was rather successful for you.
The first major milestone for BCG treatment is to complete 6 weeks of induction treatment and the first maintenance treatment after 3 months. Dr. Kamat of MD Anderson said for CIS, the complete response is about 50% and it becomes 80% the first maintenance treatment is completed. A 2009 study of BCG on Ti High Grade by Dr. Michael O'dennel of the University of Iowa states that "Multiple studies of intravesical BCG immunotherapy in T1Hg bladder cancer have reported a disease-specific survival rate of 85% to 90%". So, your prognosis looks good.
Gemcitabine for treating bladder cancer is not new. Yes, for historical reason, the fact Mitomycin was discovered in 1955 and developed for cancer treatment soon vs Gemcitabine was first approved for medical use in 1995, Mitomycin is more widely used. Incidentally, both are now being manufactured by generic drug companies outside of North America.
The mechanism of Mitomycin and Gemcitabine to kill cancer cells is to prevent DNA to replicate itself by preventing double-stranded DNA to separate into two single-stranded DNA in the process of the cancer cells dividing into two daughter cells. Both drugs will penetrate into the nucleus of the cancer cell and prevent DNA to replicate and lead it to die. The cell - cancer or normal cell - division happens in multiple stages. G1 - Grow 1 phase, S - DNA synthesis phase, G2- Glow 2 phase, and M - Mitotic phase. M is when the cell divides into two daughter cells.
Mitomycin and Gemcitabine work in the S phase. Docetaxel in M phase.
Mitomycin is classified as "antitumor antibiotics". Gemcitabine is classified as an antimetabolite. Docetaxel is classified as a "plant alkaloid". a "taxane" and an "antimicrotubule agent".
The use of Gemcitabine for treating bladder cancer is not new. I see already a paper published in 2012 that provided a systematic review of intravesical Gemcitabine used for bladder cancer treatment. In the paper, it says
gemcitabine had less recurrence (28% vs 39%) and less progression (11% vs 18%) compared to mitomycin. The side effects of gemcitabine were significantly less (38.8% vs 72.2%) compared to mitomycin. Another more recent study also indicated fewer side effects of gemcitabine. Considering that you had to halt BCG because of its side effects and because fewer side effects compared to mitomycin and equivalent or better efficacy than mitomycin, the choice of gemcitabine seemed to be the right choice in your case.
Of course, what makes a good treatment is whether it is working for a particular individual. In your case, you have been no evidence of cancer for almost 4 years, 2 years with BCG, and 2 years with gemcitabine. I would be cherishing the success you have had so far.
Urologists have to care not just for bladder cancer patients but other patients with urological diseases. I have noticed that those urologists who are involved in clinical research for bladder cancers are those who have a special interest in bladder cancer. Those doctors are trying to find better treatment/drug than BCG as BCG has side effects, some patients do not respond well to BCG, and these BCG shortages force the urologist to give sub-optimum treatment. So, those who rather specialize in bladder cancer try different clinical research by combining different treatments to see if it improves efficacy. The combination of gemcitabine and docetaxel is of them. This combination makes sense because each drug attacks cancer cells in different phases of cell division phases. If the cancer cells survive from gemcitabine in the S phase, docetaxel tries to the cell division in the M cycle. As matter of fact, they tried first giving them together but the result was not good. So, they tried sequentially, first gemcitabine and docetaxel next. The clinical study by the University of Iowa, led by Dr. O'donnel showed a good result. Then Dr. Lamm and the University of Arizona tried thermal sequential gemcitabine and docetaxel treatment, which further improved the result. (The result was published in 2019). The downside of gemcitabine/docetaxel is that it takes extra work for the hospital or clinic. The staff needs to be trained for the procedure. So, I would say that gemcitabine/docetaxel treatment is not commonly used.
So, I only know four hospitals/urologist, which are all associated with their university, who provide gemcitabine and docetaxel treatment. University of Iowa - Dr. Michael O'Donnell. University of Arizona - Dr. Lamm (private practice), Dr. Josua J Meeks - Northwestern Medicine, Dr. Peter Black - University of British Columbia.
Incidentally, you will not have to take gemcitabine for the rest of your life. Yes, you may need to have yearly cystoscopy but not gemcitabine.
Best wishes
pubmed.ncbi.nlm.nih.gov/22313502/ 2012 International Journal of
