RE:Keytruda = $265,000 (17 doses per year)Not impressive ... on any fronts
Gemcitabine + Docetaxel = $172,000 (6 doses total) Intravesical gemcitabine/docetaxel for NMIBC appears safe and efficacious April 7, 2023
The efficacy and tolerability of Gem/Doce in this cohort study appear to be at least comparable, if not superior, to BCG. The BCG supply-and-demand equation is not likely be solved in the foreseeable future. Yet tens of thousands of patients with NMIBC will continue to require effective intravesical therapy in order to preserve the bladder and avoid radical cystectomy. The ongoing randomized clinical trials, such as the BRIDGE study (NCT05538663), comparing intravesical BCG and Gem/Doce, will provide invaluable insight into the effectiveness of this combination chemotherapy.
There are a few issues specific to Gem/Doce instillation, such as more complex workflow and longer encounter time, that need to be managed by the healthcare providers and clinic staff. When adequate BCG supply is available, it is still the preferred first-line therapy for high-risk NMIBC due to extensive experience with its known response rate and toxicity profile. However, out of necessity, Gem/Doce is being offered as the first-line intravesical therapy for newly diagnosed NMIBC at our center and many other centers. The current study is welcome news as it lends further support to the use of intravesical Gem/Doce as a safe and effective option which has the potential to become a new standard of care for high-risk NMIBC.