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New treatment allows cancer patients to avoid going under the knife
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Australian hospitals have adopted a new combination chemotherapy for bladder cancer that has brought remission rates to 60 per cent, taking patients out from under the knife.
A blend of the drugs Gemcitabine and Docetaxel has seen patients sidestep side effects while cutting rates of surgical bladder removal since being trialled at Monash Health in 2023, with the treatment now available to hospitals.
Hailed as a means to 'change the whole protocol for the treatment of bladder cancer', the combination takes medications already made affordable by the Pharmaceutical Benefits Scheme to an eligible population of thousands of patients.
The drugs are referred to collectively as Gem-Doce.
It represents the first non-surgical alternative in bladder cancer treatment since the decades-old introduction of tuberculosis drug Bacillus Calmette-Guerin, for which supply is volatile.
Retired teacher Alan Feher, 72, was a successful recipient of the combination therapy after he was diagnosed with aggressive bladder cancer. He had been late to catch his cancer, given he is colour blind and missed the most obvious symptom of blood in his urine. He was also misdiagnosed with an enlarged prostate in 2018 before landing on the true cause of his symptoms.
'It's quite by accident that the process started because I was mainly concerned about prostate cancer, and didn't have much idea about bladder cancer,' he said. 'The biopsy showed two things: that it was a non-invasive bladder cancer, and it was also high grade.
'The urologist said it was normal to remove the bladder and the prostate … that's looking at quite radical surgery, which would have meant having some kind of a bag hanging off of my body, where the kidneys redirected outside of my body … I nearly fainted when I heard that.'
Facing the prospect of surgery, his entrance into the 2023 drug trial led him into remission.
Urological Society of Australia and New Zealand president Damien Bolton welcomed the successful combination therapy, pointing to rising death rates from bladder cancer as an indication of how necessary new treatments were. Its lethality has risen in line with Australia's ageing population.
Weranja Ranasinghe. Picture: Monash Health
Urological Society of Australia and New Zealand president Damien Bolton.
'One way we can hold back and hopefully cure bladder cancer is not by having a big operation to remove your bladder and give you a stoma, or by having chemotherapy and radiation which have serious toxicities, but by putting different anti-cancer agents into the bladder, and this combination … Gem-Doce, is a huge step forward for that,' he said.
'Since the time of Covid, there's been a shortage worldwide of BCG … in Australia, like many countries around the world, we've had to ration our use.
'Now with Gem-Doce, you've got the ability to reserve BCG for when it's most needed, and you've got another viable alternative.'
Professor Bolton said he hoped, pending the therapy's success, it would be adopted into recommended treatment guidelines.
Annually, more than 3000 Australians are diagnosed with bladder cancer, most aged over 50. An aggressive cancer, it disproportionately affects men.
In isolation, Gemcitabine and Docetaxel are poor treatments for bladder cancer; when administered together, 60-69 per cent of patients respond positively.
A simultaneous European study has reported a 79 per cent high-grade disease-free survival rate and 73 per cent overall disease-free survival rate.
Monash Health study lead Weranja Ranasinghe said the therapy would take patients out of palliative care.
'This new treatment provides an excellent alternative for these patients with good tolerance and durability. The other advantage is that these agents are widely available and affordable,' Associate Professor Ranasinghe said.
'The new treatment, Gem-Doce, is (using) established chemotherapy medicines and administering them sequentially into the bladder is shown to be effective in about 60 to 69 per cent of patients who don't respond to BCG treatment or who want to preserve their bladder.'
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