Time toxicity of intravesical BCG versus sequential intravesical gemcitabine and docetaxel for non-muscle-invasive bladder cancer.

OBJECTIVES

This study aimed to evaluate the time toxicity of intravesical BCG compared to sequential intravesical gemcitabine and docetaxel (Gem/Doce) for non-muscle-invasive bladder cancer (NMIBC).

PATIENTS AND

METHODS

After IRB approval, we retrospectively reviewed patients with NMIBC treated with BCG or Gem/Doce between 2022 and 2025 at our institution. Medical records were used to calculate time for intravesical therapy, office visits, transurethral resection of bladder tumour (TURBT) and emergency department encounters. Continuous variables were compared using the Wilcoxon rank sum test with Hodges-Lehmann estimates.

RESULTS

Of 133 patients, 86 received BCG (65%) and 47 Gem/Doce (35%). Patients with BCG were more likely treatment naïve compared to those with Gem/Doce (77% vs 55%, p = 0.018). Median time per instillation was 179 min for BCG compared to 192 min for Gem/Doce (Hodges-Lehmann shift +27 min, 95% CI 4 to 57; p = 0.02). Median TURBT time, office visit time and emergency department visit time were similar between groups (all p > 0.05). Over the first six instillations, the cumulative difference was 306 min (+5.1 h, p < 0.001).

CONCLUSION

Gem/Doce requires a greater time investment than BCG. As effective NMIBC therapies expand, time toxicity should be considered alongside oncologic outcomes.