A Gencitabina como Alternativa Terapêutica na Ausência de BCG: A Experiência do CHLC (Hospital S. José)

Introduction: The non-muscle invasive bladder tumors should be stratified into risk groups so the adjuvant treatment after surgery can be suited to each patient. The high risk tumors should be treated with one to three-year maintenance intravesical bacillus Calmette-Guerin (BCG). It has been reported shortages of intravesical BCG and our hospital center was affected in 2014/2015, leading to a treatment change of the patients who had indication to BCG. Gemcitabine could be a valid alternative because some studies show it may have a role in intermediate-risk patients, as an alternative to mitomycin C, and in high risk, BCG-refractory patients, with a better toxicity profile. Material and Methods: This is a descriptive, retrospective study that included patients with non-muscle invasive bladder tumors of high risk with onset of disease in 2013/2014, affected by the BCG shortage period at the Hospital Center. Results: At CHLC, 11 high-risk patients were treated with gemcitabine, only two exclusively, and the others sequentially with BCG. Only two patients, treated with both gemcitabine and BCG, had tumoral recurrence. However, a significant number (6 out of 11) had adverse events, two of whom had to stop treatment. Conclusion: Apparently, gemcitabine seems to be a good adjuvant treatment choice during the shortage of the gold standard treatment, due to the low number of recurrence, although adverse events reported were high.