Alopecia following single-dose postoperative intravesical gemcitabine in nonmuscle-invasive bladder cancer: A multi-institutional case series

Anosh Dadabhoy; Chirag Doshi; Mazyar Zahir; Sanam Ladi-Seyedian; Domenique Escobar; Leilei Xia; Anne Schuckman; Christopher B Anderson; Max Kates; Piyush K Agarwal; Seth P Lerner; Karim Chamie; Alon Weizer; Siamak Daneshmand

doi:10.1016/j.urolonc.2025.12.020

Alopecia following single-dose postoperative intravesical gemcitabine in nonmuscle-invasive bladder cancer: A multi-institutional case series

Urol Oncol. 2026 Mar;44(3):110984. doi: 10.1016/j.urolonc.2025.12.020. Epub 2026 Jan 12.

Authors

Affiliations

¹ University of Southern California, Los Angeles, CA.
² Columbia University, New York, NY.
³ Johns Hopkins University, Baltimore, MD.
⁴ University of Chicago, Chicago, IL.
⁵ Baylor College of Medicine, Houston, TX.
⁶ University of California, Los Angeles, CA.
⁷ University of Michigan, Ann Arbor, MI; Mount Sinai Medical Center, Miami Beach, FL.
⁸ University of Southern California, Los Angeles, CA. Electronic address: daneshma@med.usc.edu.

PMID: 41529351
DOI: 10.1016/j.urolonc.2025.12.020

Abstract

Introduction: Single-dose intravesical gemcitabine therapy (IVGT) is a standard of care option following transurethral resection (TURBT) for low- to intermediate-risk nonmuscle invasive bladder cancer (NMIBC). The side-effect profile of IVGT has primarily focused on well-established urinary symptoms. Herein we present several cases of treatment-related alopecia following a single postoperative dose of IVGT for NMIBC.

Methods: Urologic oncologists from 7 high-volume bladder cancer referral centers in the United States were surveyed about incidents of alopecia, as well as the severity of hair loss, following a single postoperative dose of IVGT after TURBT- either for primary or for known NMIBC. Patients were identified either through self-reported concerns or by physician-observed alopecia during follow-up visits.

Results: Between January 2020 and December 2024, a total of 20 patients (6 male, 14 female) experienced hair loss, with the majority (N = 12, 60%) occurring within the first month post-TURBT. Thirteen of the 20 patients (65%) experienced severe alopecia. None of the patients were on medications known to cause hair loss or receiving other chemotherapy. Five patients had large resections (>5 cm), ten had medium (2-5 cm), and 5 had small (<2 cm) resections. Two patients had previously received IVGT without hair loss. Additionally, 4 patients had previously received intravesical Bacillus Calmette-Guérin (BCG), and 1 had received intravesical mitomycin C. No cases of bladder perforation were reported.

Conclusion: Hair loss appears to be an underreported side effect of IVGT post-TURBT. Patients should be counseled about this potential adverse event prior to treatment, and routine inquiry regarding alopecia should be considered in those undergoing IVGT post-TURBT. Prospective multicenter studies are encouraged to better evaluate the incidence and risk factors associated with this adverse event.

Keywords: Alopecia; Gemcitabine; Intravesical instillation; Side effects; Transurethral resection of bladder.

Publication types

Multicenter Study

MeSH terms

Administration, Intravesical
Aged
Aged, 80 and over
Alopecia* / chemically induced
Antimetabolites, Antineoplastic* / administration & dosage
Antimetabolites, Antineoplastic* / adverse effects
Deoxycytidine* / administration & dosage
Deoxycytidine* / adverse effects
Deoxycytidine* / analogs & derivatives
Female
Gemcitabine
Humans
Male
Middle Aged
Non-Muscle Invasive Bladder Neoplasms* / drug therapy
Transurethral Resection of Bladder
Urinary Bladder Neoplasms* / drug therapy
Urinary Bladder Neoplasms* / surgery

Substances

Deoxycytidine
Gemcitabine
Antimetabolites, Antineoplastic