PATIENT NAME: ________________________________
DIAGNOSIS/DATE: ______________________________
GEMCITABINE/DOCETAXEL THERAPY INFORMATION
WHAT IS GEMCITABINE/DOCETAXEL?
GEMCITABINE/DOCETAXEL (GEM/DOCE) THERAPY IS A BLADDER INSTILLATION TREATMENT WE OFFER PATIENTS WITH NON-INVASIVE BLADDER CANCER THAT REDUCES THE RISK OF RECURRENCE AND PROGRESSION OF BLADDER TUMORS. IT IS AN ALTERNATIVE TO BCG THERAPY. WE INSTILL THE MEDICATIONS WITH A URETHRAL CATHETER AT EACH SESSION.
WHAT IS INDUCTION THERAPY?
GEM/DOCE INDUCTION THERAPY CONSISTS OF 6 WEEKLY BLADDER INSTILLATIONS. EACH SESSION INVOLVES TWO SEPARATE INSTILLATIONS - FIRST GEMCITABINE (RETAINED FOR 90 MINUTES) FOLLOWED BY DOCETAXEL (RETAINED FOR 90-120 MINUTES).
WHAT IS MAINTENANCE THERAPY?
MAINTENANCE THERAPY CONSISTS OF MONTHLY TREATMENTS FOR 24 MONTHS. THE ADDITION OF MAINTENANCE THERAPY DECREASES THE RISK OF DISEASE RECURRENCE AND PROGRESSION. CYSTOSCOPY IS PERFORMED AFTER EVERY 3 MONTHLY TREATMENTS.
WHAT ARE THE TYPES OF NON-INVASIVE BLADDER CANCER?
LOW GRADE: LESS AGGRESSIVE FORM OF CANCER. LOW GRADE CANCER CAN RECUR, BUT IT IS LESS LIKELY TO PROGRESS AS COMPARED TO HIGH GRADE.
HIGH GRADE: THIS IS A MORE AGGRESSIVE FORM OF UROTHELIAL CARCINOMA. HIGH GRADE CANCERS HAVE A HIGHER CHANCE OF PROGRESSING TO MUSCLE INVASIVE DISEASE AND METASTASIS.
TREATMENT EFFICACY
GEM/DOCE THERAPY HAS SHOWN EXCELLENT RESULTS IN CLINICAL STUDIES:
  • 1-YEAR RECURRENCE-FREE SURVIVAL: 85%
  • 2-YEAR RECURRENCE-FREE SURVIVAL: 82%
  • PROGRESSION TO MUSCLE-INVASIVE DISEASE: 0% IN RECENT STUDIES
WHAT MEDICATIONS SHOULD I TAKE?
BEFORE EACH TREATMENT:
  • SODIUM BICARBONATE: 1300mg (TWO 650mg TABLETS)
    • TAKE ONE TABLET THE NIGHT BEFORE TREATMENT
    • TAKE ONE TABLET THE MORNING OF TREATMENT
    • (ALTERNATIVE: K-CIT IF YOU ARE ON SODIUM RESTRICTION)
  • OPTIONAL PAIN RELIEF:
    • NAPROXEN (ALEVE) 220mg 30-60 MINUTES BEFORE PROCEDURE
WHAT SHOULD I AVOID BEFORE TREATMENT?
  • AVOID EATING OR DRINKING FOR 12-14 HOURS BEFORE TREATMENT
  • AVOID ALCOHOL AND COFFEE
  • AVOID ALL DIURETICS WITHIN 8 HOURS OF TREATMENT
AFTER TREATMENT MEDICATIONS
FOR URINARY FREQUENCY/URGENCY & BLADDER SPASMS:
  • OXYBUTYNIN 5mg TWICE DAILY OR
  • SOLIFENACIN 5-10mg DAILY
FOR PAIN/DISCOMFORT:
  • IBUPROFEN 600mg THREE TIMES DAILY OR
  • NAPROXEN 220mg TWICE DAILY
  • FOR SEVERE PAIN: CONTACT YOUR DOCTOR
WHAT ARE POSSIBLE SIDE EFFECTS?
GEM/DOCE CAN CAUSE BLADDER IRRITATION, URGENCY AND FREQUENCY IN ABOUT 36% OF PATIENTS. THIS USUALLY STOPS WITHIN A FEW DAYS AFTER EACH TREATMENT.
OTHER POSSIBLE SIDE EFFECTS INCLUDE:
  • HEMATURIA (BLOOD IN URINE) - 11% OF PATIENTS
  • DYSURIA (PAINFUL URINATION) - 8% OF PATIENTS
  • BLADDER SPASMS
  • PELVIC DISCOMFORT
WHEN SHOULD I CALL THE CLINIC?
CALL THE CLINIC IF YOU EXPERIENCE:
  • SEVERE OR WORSENING PAIN THAT IS NOT RELIEVED BY MEDICATION
  • SEVERE HEMATURIA (BRIGHT RED BLOOD IN URINE)
  • INABILITY TO URINATE
  • FEVER OVER 101°F
  • CHILLS OR SHAKING
  • SYMPTOMS THAT WORSEN OR DO NOT IMPROVE AFTER 48 HOURS
IMPORTANT REMINDERS
  • EACH GEM/DOCE TREATMENT INVOLVES TWO SEPARATE INSTILLATIONS:
  • FIRST GEMCITABINE - RETAINED FOR 90 MINUTES
  • THEN DOCETAXEL - RETAINED FOR 90-120 MINUTES
  • TOTAL TREATMENT TIME IS APPROXIMATELY 3-4 HOURS
  • TAKE SODIUM BICARBONATE AS DIRECTED BEFORE EACH TREATMENT
  • REPORT ANY SEVERE SIDE EFFECTS TO YOUR DOCTOR IMMEDIATELY
CLINIC CONTACT INFORMATION
CLINIC PHONE: _______________________________

AFTER HOURS: _______________________________

NEXT APPOINTMENT: __________________________
PATIENT NAME: ________________________________
DIAGNOSIS/DATE: ______________________________
GEM/DOCE THERAPY SCHEDULE FOR NON-MUSCLE INVASIVE BLADDER CANCER
GEM/DOCE INDUCTION 2-3 WEEKS POST TURBT
GEM/DOCE INDUCTION #1
GEM/DOCE INDUCTION #2
GEM/DOCE INDUCTION #3
GEM/DOCE INDUCTION #4
GEM/DOCE INDUCTION #5
GEM/DOCE INDUCTION #6
CYSTOSCOPY #1 - 4-6 WEEKS POST INDUCTION
MAINTENANCE THERAPY
MONTH 1 MAINTENANCE
MONTH 10 MAINTENANCE
MONTH 19 MAINTENANCE
MONTH 2 MAINTENANCE
MONTH 11 MAINTENANCE
MONTH 20 MAINTENANCE
MONTH 3 MAINTENANCE
MONTH 12 MAINTENANCE
MONTH 21 MAINTENANCE
CYSTOSCOPY #2
CYSTOSCOPY #5
CYSTOSCOPY #8
MONTH 4 MAINTENANCE
MONTH 13 MAINTENANCE
MONTH 22 MAINTENANCE
MONTH 5 MAINTENANCE
MONTH 14 MAINTENANCE
MONTH 23 MAINTENANCE
MONTH 6 MAINTENANCE
MONTH 15 MAINTENANCE
MONTH 24 MAINTENANCE
CYSTOSCOPY #3
CYSTOSCOPY #6
FINAL CYSTOSCOPY
MONTH 7 MAINTENANCE
MONTH 16 MAINTENANCE
MONTH 8 MAINTENANCE
MONTH 17 MAINTENANCE
MONTH 9 MAINTENANCE
MONTH 18 MAINTENANCE
CYSTOSCOPY #4
CYSTOSCOPY #7