Long-term BCG immune therapy of superficial bladder tumours (original) (raw)
Related papers
Immunotherapy of superficial bladder cancer with BCG
World Journal of Urology, 1986
Bacillus Calmette-Gu6rin (BCG) has achieved an important role in the prophylaxis and treatment of superficial bladder cancer. It has been found effective in the prevention of recurrences after endoscopic surgery as well as in the treatment of residual tumors. The most dramatic responses have been consistently demonstrated in the treatment of carcinoma in situ. Recent experience suggests that prolongation of treatment beyond the 6 weeks advocated in early protocols, significantly increases the anti-tumor activity of BCG. The side effects of intravesical administration of the vaccine are, in the vast majority of patients, well-tolerated, minimal and self-limiting. No permanent functional or structural damage of the bladder has been observed. The effectiveness of BCG is primarily dependent on the strain used as well as the dose, duration and frequency of its administration.
Arab Journal of Urology, 2015
Objectives: To determine whether a half-dose of bacille Calmette-Gue´rin (BCG) can reduce toxicity without affecting its efficacy in the management of nonmuscle-invasive bladder cancer. Patients and methods: From January 2012 to January 2014, 80 patients with superficial bladder cancer and in the intermediate-risk group were simply randomised to receive two different doses of BCG, i.e., a full dose of 90 mg (group A) or a half-dose of 45 mg (group B). There were no significant differences in clinical and pathological characteristics between the groups. At completion of the study, 40 patients could be evaluated in each group. Results: All patients were evaluated for a follow-up of 12 months after treatment. There was no significant difference in recurrence rate (15 patients, 38%, in group A and 16, 40%, in group B) in the two groups, and no difference in progression rate of the disease, at eight patients (20%) in each group. There were significant differences
International Urology and Nephrology, 1998
In this study, we evaluated low dose intravesical bacillus Calmette-Guerin (BCG) therapy following transurethral resection (TUR) in 80 patients with superficial bladder cancer. The patients were divided into two groups. Of the Connaught BCG strain 81 mg was given to 40 patients in Group 1 and 54 mg to the remainder of 40 patients in Group 2. BCG was introduced once a week for 6 weeks. Tumour recurrence was seen in 6 patients in Group 1 and in 10 patients in Group 2. Recurrence rates per month were 0.71 and 1.49, respectively. There was no significant difference in complication rates. These data suggest that while the standard dose (81 rag) intravesical therapy of BCG is more effective than the low dose, there was no significant difference in side effects between the two groups.
Nature reviews. Urology, 2015
Multiple clinical trials have demonstrated that intravesical Bacillus Calmette-Guérin (BCG) treatment reduces recurrences and progression in patients with non-muscle-invasive bladder cancer (NMIBC). However, although BCG has been in use for almost 40 years, this agent is often underutilized and practice patterns of administration vary. This neglect is most likely caused by uncertainties about the optimal use of BCG, including unawareness of optimal treatment schedules and about patient populations that most benefit from BCG treatment. To address this deficit, a focus group of specialized urologic oncologists (urologists, medical oncologists and radiation oncologists) reviewed the current guidelines and clinical evidence, discussed their experiences and formed a consensus regarding the optimal use of BCG in the management of patients with NIMBC. The experts concluded that continuing therapy with 3-week BCG maintenance is superior to induction treatment only and is the single most imp...
What Are the Immunologically Active Components of BCG in BCG Therapy of Superficial Bladder Cancer?
The Journal of Urology, 1999
The subcomponents of bacille Calmette-Gué rin (BCG) involved in the mechanism of action of intravesical BCG immunotherapy used for prophylaxis of superficial bladder cancer recurrences have been poorly investigated. We purified various BCG subcomponents and analyzed in vitro their ability to enhance a Th1 polarized immune response as well as to increase lymphocyte-mediated cytotoxicity against bladder tumors. Human peripheral blood mononuclear cells (PB-MCs) from healthy purified protein derivative-positive subjects were incubated for 7 days with whole BCG and various fractions (BCG cell wall, plasma membrane, cytosol, purified polysaccharides as glucan or arabinomannan, purified native proteins from BCG culture filtrate, recombinant 22 kDa protein, phosphate transporter PstS-2 and -3 proteins). IFN-␥, . IL-2 receptor blockage resulted in a clear reduction in the cytotoxic activity of stimulated PBMCs. Numerous BCG subcomponents thus provide positive stimuli for Th1 cell differentiation and enhance in vitro, non-MHC-restricted cytotoxicity against bladder tumor cells. Our findings provide the basis for the therapeutic use of several of these subfractions in experimental animal models bearing bladder tumors. Int.
BCG immunotherapy for non-muscle invasive bladder cancer: is efficacy related to toxicity?
Bladder
OBJECTIVES: To examine the prevalence of local and systemic adverse effects (AEs) associated with Bacillus Calmette-Guerin (BCG) immunotherapy for non-muscle invasive bladder cancer (NMIBC) and to determine if there was any relationship between adverse effects and efficacy of treatment. PATIENTS AND METHODS: Patients receiving induction intravesical BCG immunotherapy for NMIBC from 1995 to 2013 were identified from a group urology practice. Patients completed an AE scoresheet and an AE was recorded if the patient experienced the symptom at any point in the week following instillation. Patients were dichotomised based on recurrence status (treatment efficacy was defined as non-recurrence) and association with AEs was investigated using univariate Cox regression analysis. RESULTS: One hundred and fifty eight patients were examined with a mean age of 70.2 years (range 41-88) and a male predominance (125, 79%). The most prevalent local AEs were frequency (107, 68%), dysuria (98, 62%) and nocturia (95, 60%). Malaise (54, 34%), myalgia (41, 26%) and fever (32, 20%) were the most common systemic AEs. Recurrence status was available for 82 patients, with 43 (52%) diagnosed with recurrence. There was no significant relationship between overall AEs and recurrence [hazard ratio (HR) 0.97, P = 0.57], or for local (HR 0.99, P = 0.90) and systemic (HR 0.88, P = 0.32) AEs. Only frequency was significantly associated with reduced recurrence (HR = 0.42, P = 0.04). CONCLUSIONS: AEs due to BCG immunotherapy are common in the induction period with nearly 70% of patients in our cohort experiencing individual symptoms. Local AEs are considerably more prevalent than systemic. Frequency was the only AE to be significantly associated with non-recurrence. Overall, AEs due to BCG instillation treatment were not related to efficacy for NMIBC.