BCG immunotherapy of bladder cancer: 20 years on

AB Alexandroff, AM Jackson, MA O'Donnell, K James - The Lancet, 1999 - thelancet.com
AB Alexandroff, AM Jackson, MA O'Donnell, K James
The Lancet, 1999thelancet.com
Review this adequately. What is certain is that BCG is not effective for muscle-invasive
disease, or for tumours that lie out of direct contact with BCG such as those deep within the
prostate or in the upper urinary tract. Transitional cell tumours of the upper tract can be
effectively treated if BCG is dripped directly into the upper collecting system. 12 The use of
BCG for bladder cancer does not come without drawbacks. First, the response to BCG is
unpredictable. 11 There are currently no reliable prognostic factors that accurately predict …
Review this adequately. What is certain is that BCG is not effective for muscle-invasive disease, or for tumours that lie out of direct contact with BCG such as those deep within the prostate or in the upper urinary tract. Transitional cell tumours of the upper tract can be effectively treated if BCG is dripped directly into the upper collecting system. 12 The use of BCG for bladder cancer does not come without drawbacks. First, the response to BCG is unpredictable. 11 There are currently no reliable prognostic factors that accurately predict treatment success or failure. Second, BCG has side-effects. 13 Most patients experience local symptoms of cystitis including frequency, urgency, dysuria, and occasional haematuria. Mild systemic symptoms of high temperature, malaise, and a transient influenza-like illness are also common. Severe side-effects occur in 5% of patients, roughly 10% of which involve frank BCG sepsis. Seven deaths due to BCG sepsis from bladders instillations have been documented. In nearly all cases the deaths were attributed to inappropriate BCG administration at the time of surgery or recent urethral trauma, situations that would favour intravasation.
Despite two decades of clinical use, there has been little change in the BCG dose and treatment schedule originally operationally defined by Morales and colleagues in 1976, which involved once-a-week BCG instillation for 6 weeks and an evaluatory cystoscopy at 12 weeks. Although this was once widely practised, it has now been shown that simultaneous percutaneous scarification does not provide any added benefit.
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