Inclusion And Exclusion Criteria
The study inclusion criteria were shown as follows: randomized controlled trials as well as quasi-RCTs studies that comprised medium- to high-risk patients who occupies 1544% NMIBC cases in certain series studies that mentioned clinical outcomes, Ta or T1 tumor and included patients receiving intravesical gemcitabine comparing with mitomycin.
The study exclusion criteria were as follows: non-RCTs studies in which cases with other neoplasm studies with incomplete information to analysis duplicate articles.
Subgroup Analysis And Sensitivity Analysis
Subgroup analysis in reference to RFS is conducted to examine the sources of heterogeneity . Subgroups include study, intervention, and tumor characteristics, such as study design, study origin, study center, schedule, and risk of recurrence. However, the level of heterogeneity for the subgroup is similar to that for the total effect, indicating that the heterogeneity is not originated from these study features. Figure 4 shows the results of sensitivity analysis for both RFS and PFS. All the pooled effect sizes after omitting study are in the 95% CI range of overall effect size, reflecting the robustness of the results.
How Often Do You Have Gemcitabine
You usually have gemcitabine as a course of several cycles of treatment. This means that you have the drug and then a rest to allow your body to recover. Usually a cycle of gemcitabine is over 3 to 4 weeks .
You usually have gemcitabine once a week for 2 or 3 weeks and then a week with no treatment. You have gemcitabine on its own or in combination with other cancer drugs. You can also have it alongside radiotherapy treatment depending on your cancer type.
The exact number of cycles and how long the cycle is, depends on your cancer type. Your healthcare team will explain your specific treatment plan to you.
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When To Contact Your Team
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
- you have severe side effects
- your side effects arent getting any better
- your side effects are getting worse
Early treatment can help manage side effects better.
We haven’t listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.
Efficacy Of Bladder Intravesical Chemotherapy With Three Drugs For Preventing Non
Zhixin Ling
1Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
Abstract
1. Introduction
Bladder cancer has the clinical characteristics of high recurrence rate, high progression rate, and high mortality rate. Most of it comes from epithelial tissue. The urothelial cell carcinoma accounts for nearly 90% of bladder cancer worldwide . According to the extent of cancer cells invading the bladder wall, non-muscle-invasive bladder cancer and muscle-invasive bladder cancer are the two main types of bladder cancer, and non-muscle-invasive bladder cancer is among the most common types of bladder cancer. The non-muscle-invasive bladder cancer is responsible for 75%85% of newly diagnosed cases .
2. Materials and Methods
2.1. Research Object
This study retrospectively analyzed a total of 335 intermediate- and high-risk patients who underwent transurethral bladder tumor resection in our hospital from October 2015 to October 2019, and they were regularly perfused with epirubicin, gemcitabine, and pirarubicin. The risk of patients was classified with intermediate- or high-risk non-muscle-invasive bladder cancer. According to the different perfusion drugs, the patients were divided into an epirubicin group , gemcitabine group , and pirarubicin group .
2.1.1. Inclusion Criteria
2.1.2. Exclusion Criteria
2.2. Surgical Plan
2.3. Perfusion Scheme
2.4. Follow-Up
2.5. Observation Indicators
2.6. Data Analysis
3. Results
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Physical Emotional And Social Effects Of Cancer
Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after an advanced cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.
If Treatment Does Not Work
Full recovery from bladder cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or metastatic.
This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, expertise, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is a specific type of palliative care designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
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Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place , nearby , or in another place .
If a recurrence happens, a new cycle of testing will begin again to learn as much as possible about it. After this testing is done, you and your doctor will talk about the treatment options.
People with recurrent cancer sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.
Berberine Enhances Gemcitabineinduced Cytotoxicity In Bladder Cancer By Downregulating Rad51 Expression Through Inactivating The Pi3k/akt Pathway
This article is mentioned in:
Abstract
in vivo
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Efficacy And Toxicity In Scheduled Intravesical Gemcitabine Versus Bacille Calmette
Department of Urology, Tongji Hospital, Tongji Medical College , Huazhong University of Science and Technology , , China
Contributions: Conception and design: JL Lu, QD Xia Administrative support: HL Hu, SG Wang Provision of study materials or patients: JL Lu, QD Xia, HL Hu, SG Wang Collection and assembly of data: JL Lu, QD Xia, CQ Liu, JX Sun, YY Yang Data analysis and interpretation: JL Lu, QD Xia Manuscript writing: All authors Final approval of manuscript: All authors.
#These authors contributed equally to this work.
^ORCID: Jun-Lin Lu, 0000-0002-3438-0297 Qi-Dong Xia, 0000-0002-2278-1122 Shao-Gang Wang, 0000-0002-3206-1495.
Correspondence to:
Background: We conducted a meta-analysis to compare the efficacy and toxicity of scheduled intravesical gemcitabine and Bacille Calmette-Guérin for Ta and T1 non-muscle invasive bladder cancer .
Methods: The database search was performed in Ovid Medline, Embase, Web of Science, Cochrane Library from the commencement of the database to July 7, 2020. Trials using immediate instillation were excluded and we present the included studies in accordance with the PRISMA 2020 reporting checklist. The data extracted was analyzed using Stata 11.0 software.
Keywords: Gemcitabine Bacille Calmette-Guérin non-muscle invasive bladder cancer meta-analysis tumor recurrence
Submitted Feb 16, 2021. Accepted for publication Apr 16, 2021.
doi: 10.21037/tcr-21-291
Feeling Or Being Sick
Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.
It is important to take anti sickness medicines as prescribed even if you dont feel sick. It is easier to prevent sickness rather than treating it once it has started.
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Increased Risk Of Getting An Infection
Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.
Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.
Intravesical Gemcitabine For Non
Review question
In people with tumors of the superficial layer of the urinary bladder , how does gemcitabine that is put into the bladder compare to other medicines after the tumor has been removed?
Background
NMIBC can be taken out of the bladder using small instruments and a light source . However, these tumors often come back with an aggressive feature such as spread into the deep layers of the bladder. To prevent this, we can put various medicines into the bladder. In this review, we wanted to know whether gemcitabine was better or worse than other medicines.
Study characteristics
The evidence is current to 11 September 2020. We included only studies in which chance determined whether people received gemcitabine or other medicines. We found seven studies with 1222 participants. Two studies compared gemcitabine versus saline. One study compared gemcitabine versus mitomycin . Three studies compared gemcitabine versus BCG . One study compared gemcitabine versus one-third dose BCG.
Key results
Reliability of the evidence
The reliability of the evidence was low or very low for most of the treatments we compared, meaning that we were often uncertain about whether the findings were true. Further research will likely change these findings.
To assess the comparative effectiveness and toxicity of intravesical gemcitabine instillation for NMIBC.
We included RCTs in which participants received intravesical gemcitabine for primary or recurrent NMIBC.
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How Do You Have Gemcitabine
You have gemcitabine into your bloodstream . It takes about 30 minutes.
You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:
- central line
- Portacath
If you dont have a central line
You might have treatment through a thin short tube that goes into a vein in your arm each time you have treatment.
Intravesical Therapy For Bladder Cancer
With intravesical therapy, the doctor puts a liquid drug right into your bladder rather than giving it by mouth or injecting it into your blood. The drug is put in through a soft catheter that’s put into your bladder through your urethra. The drug stays in your bladder for up to 2 hours. This way, the drug can affect the cells lining the inside of your bladder without having major effects on other parts of your body.
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Treatment Of Cis Versus Tcc
The diagnosis of bladder carcinoma in situ is established by a combination of cystoscopy, urine cytology, and histologic evaluation of multiple bladder biopsies. Biopsies are performed on suspicious/abnormal areas in the bladder detected by cystoscopy or by white light, photodynamic, or narrow-band imaging. Biopsies obtained in areas adjacent to an identified tumor may reveal unsuspected CIS. A study of a noninvasive test using urine samples from patients with hematuria showed an 88% sensitivity and 99.8% negative predictive value.
Treatment of bladder CIS differs from that of papillary transitional cell carcinoma . Endoscopic surgery, which is the initial treatment of papillary cancers, is not effective for CIS because the disease is often so diffuse and difficult to visualize that surgical removal is not feasible. When a combination of papillary tumor and CIS is present, the papillary tumor is removed before treatment of the CIS is initiated.
Another Option For Reducing Recurrences
Other studies have demonstrated that giving patients with low-grade bladder cancer the chemotherapy drug mitomycin C through a catheter following surgery can reduce the chance of a recurrence. These studies led professional groups in the United States and Europe to recommend this approach for patients with low-grade disease that has not invaded the muscle.
In the United States, however, few patients receive this treatment, in part because of concerns about the side effects of mitomycin C, as well as the availability and cost of the drug, noted Dr. Messing. Mitomycin C can be toxic if it leaks out of the bladder through a hole, and the drug can also cause severe rashes when it comes in contact with skin.
Gemcitabine, on the other hand, is a well-tolerated, readily available drug that “comes at relatively little cost in terms of side effects or expense,” said Dr. Messing. The side effects were similar between the two groups in the trial and were generally manageable, he added.
Some patients with advanced bladder cancer already receive gemcitabine, noted Piyush Agarwal, M.D., who heads the Bladder Cancer Section in NCI’s Center for Cancer Research and was not involved in the trial. “So, it makes sense that the drug would be used to treat patients with low-grade bladder cancer.”
Dr. Agarwal predicted that the new study would lead to revisions in treatment guidelines to include gemcitabine as an option for reducing recurrences in the patients with low-grade bladder cancer.
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Selecting And Testing Gemcitabine
When Dr. Messing began research on gemcitabine as a possible way to reduce recurrences more than a decade ago, the drug was not widely used for bladder cancer. “We tried to pick an agent that we thought would be safe and effective,” he said.
The researchers decided to compare gemcitabine against placebo rather than mitomycin C, based on studies showing how infrequently patients received some form of chemotherapy following surgery despite guidelines recommending this approach.
“If the new procedure were adopted widely, we could spare patients a lot of suffering from repeated surgeries and save health care costs associated with those surgeries,” Dr. Messing said.
“Now that we have the results of the trial,” he went on, “we hope that patients and physicians will embrace this approach to treatment.”
Chemotherapy For Bladder Cancer
Chemotherapy uses anticancer drugs to destroy cancer cells. It is sometimes used to treat bladder cancer. Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of chemotherapy. You may also receive other treatments.
Chemotherapy is given for different reasons. You may have chemotherapy to:
- destroy cancer cells in the body
- shrink a tumour before other treatments such as surgery or radiation therapy
- destroy cancer cells left behind after surgery and reduce the risk that the cancer will come back
- make cancer cells more sensitive to radiation therapy
- relieve pain or control the symptoms of advanced bladder cancer
Chemotherapy for bladder cancer that has not grown into the muscle of the bladder wall is given as intravesical therapy, which means that the drugs are placed directly into the bladder. Chemotherapy may also be a systemic therapy given through a needle into a vein. This means that the drugs travel through the bloodstream to reach and destroy cancer cells all over the body, including those that may have broken away from the primary tumour in the bladder.
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Important Message About Bcg
BCG is a standard treatment option for non-muscle invasive bladder cancer. Merck & Co., the only maker and supplier of BCG to the United States, has shared with the Urology Care Foundation that they are now experiencing a shortage of BCG due the growing use and need for this product around the world.
While Merck has raised their production of BCG, they expect this shortage to carry through 2019.
The Foundation is very concerned about this medication shortage, and we understand this situation can be stressful for patients and physicians. To help minimize disruptions to patient care, the Urology Care Foundation has been working closely with the American Urological Association , American Association of Clinical Urologists, Bladder Cancer Advocacy Network and the Society of Urologic Oncology to develop strategies to help providers treat patients with bladder cancer while this supply constraint continues.
In addition, efforts to engage the U.S. Food and Drug Administration in identifying and approving other sources of BCG are ongoing. The Urology Care Foundation remains in contact with the AUA and Merck, and will share more news on our website as it becomes available.
For further information about BCG, you may contact Merck’s National Service Center at 1-800-444-2080.