Introduction:

Single-dose administration of intravesical chemotherapy is a common part of clinical practice following transurethral resection (TURBT) of non-muscle invasive bladder cancer (NMIBC). Gemcitabine is a deoxycytidine analogue, used systemically in many tumors including non-localized bladder cancer, where it is effective and well tolerated, and is one of several choices for intravesical chemotherapy. Although the side effect profile for gemcitabine is well characterized in systemic and local therapy, rare side effects continue to be identified with ongoing use. Here we identify several cases of treatment-related alopecia after adjuvant single dose intravesical administration of gemcitabine for NMIBC. 

Methods:

Using the IRB-approved multi-institutional Cysview registry database, we identified patients who underwent TURBT for NMIBC and received a single dose of intravesical gemcitabine post-TURBT between January 2020 and June 2024 at the University of Southern California, Columbia, UCLA, Mount Sinai, Baylor, Johns Hopkins University and the University of Pennslyvania. Patients with a history of low grade NMIBC or those undergoing their first TURBT received two grams of gemcitabine dissolved in 100 cc of saline one hour after tumor resection. We reviewed patient-reported adverse effects of single dose intravesical gemcitabine and included patients who reported alopecia following gemcitabine instillation. Patients were questioned on the degree and length of hair loss. Clinicopathologic information was collected from patient charts.

Results:

Overall, 15 patients (4 male, 11 female) reported hair loss following single dose intravesical gemcitabine after the TURBT. One patient had an autoimmune disease. The hair loss started within a few days of gemcitabine instillation and resolved spontaneously. No patients were receiving any other medications known to cause hair loss or on any chemotherapy regimen at the time. Table 1 shows the clinicopathologic characteristics of this cohort in detail. Nine patients experienced severe hair loss. The resection extent during TURBT was classified as small (<2 cm), medium (2-5 cm), or large (>5 cm). Four patients had a large resection, seven patients had a medium one and 3 patients had a small resection. None of the patients had previous intravesical gemcitabine; however, 2 patients had a history of intravesical BCG and 1 had intravesical mitomycin C before.

Conclusion:

This study demonstrates that hair loss is one of the uncommon adverse effects of intravesical gemcitabine after TURBT. Prior to surgery, patients should be informed about this adverse effect. Additional research and larger multicenter studies are required to describe the occurrence and cause of this adverse event.

Funding: N/A