Maintenance cisplatin IV after cisplatin/gemcitabine for bladder cancer – pro
The question is essentialy about the appropriateness of dropping cisplatin and continuing what the providers called “maintenance” gemctibaine for metastatic bladder cancer after an initial response to the combinaiton regimen. This is being explored in a study that is still ongoing as of 11/25/09 but not recruiting patients: Gemcitabine in Treating Patients With Recurrent Bladder Cancer That Has Not Responded to Previous Bacillus Calmette-Guerin, NCT00234039. Here gemcitabine is intravesicular and cisplatin is not used.
In regard to IV therapy, Randomized phase III trial of 2nd line gemcitabine/paclitaxel chemotherapy in patients with advanced bladder cancer: Temporary versus maintenance treatment (German Association of Urologic Oncology (AUO) Trial AB 20/99) did not show an advantage to maintenance therapy.
I am not aware of other literature that supports maintenance versus intermittent gemcitabine for bladder cancer.
P. Albers, R. Siener, S. Park, G. Fechner, U. Steiner, J. Lehmann, D. Heimbach, A. Heidenreich, R. Fimmers Randomized phase III trial of 2nd line gemcitabine/paclitaxel chemotherapy in patients with advanced bladder cancer: Temporary versus maintenance treatment (German Association of Urologic Oncology (AUO) Trial AB 20/99). J Clin Oncol 26: 2008 (May 20 suppl; abstr 5030)
GFadi El Karak& Aude Flechon Gemcitabine in bladder cancer
Expert Opinion on Pharmacotherapy
December 2007, Vol. 8, No. 18, Pages 3251-3256