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. 2002 Aug;78(922):449–454. doi: 10.1136/pmj.78.922.449

Use of bacille Calmette-Guérin in superficial bladder cancer

J Meyer 1, R Persad 1, D Gillatt 1
PMCID: PMC1742458  PMID: 12185215

Abstract

Intravesical bacille Calmette-Guérin (BCG) has been used by urologists for several years after its first reported use as a cancer therapy in the 1930s. Morales in 1976 described the usage of BCG as a once weekly intravesical instillation for six weeks; this is a treatment regimen that still exists today. Its success as a treatment depends on it being used appropriately. It is employed: (1) to treat carcinoma in situ or occasionally residual papillary tumours; (2) to reduce the number and frequency of recurrent high grade superficial tumours; and (3) to prevent disease progression (although this remains a controversial point, on which there is no consensus view). Unfortunately, the more widespread use of BCG is often limited due its high side effect profile. Present research is directed towards reducing its side effect profile, improving its efficacy, and understanding its exact mechanism of action, which is not fully understood.

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Selected References

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  1. Akaza H., Hinotsu S., Aso Y., Kakizoe T., Koiso K. Bacillus Calmette-Guérin treatment of existing papillary bladder cancer and carcinoma in situ of the bladder. Four-year results. The Bladder Cancer BCG Study Group. Cancer. 1995 Jan 15;75(2):552–559. doi: 10.1002/1097-0142(19950115)75:2<552::aid-cncr2820750219>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
  2. Becich M. J., Carroll S., Ratliff T. L. Internalization of bacille Calmette-Guerin by bladder tumor cells. J Urol. 1991 Jun;145(6):1316–1324. doi: 10.1016/s0022-5347(17)38622-6. [DOI] [PubMed] [Google Scholar]
  3. Bretton P. R., Herr H. W., Kimmel M., Whitmore W. F., Jr, Laudone V., Oettgen H. F., Fair W. R. The response of patients with superficial bladder cancer to a second course of intravesical bacillus Calmette-Guerin. J Urol. 1990 Apr;143(4):710–713. doi: 10.1016/s0022-5347(17)40067-x. [DOI] [PubMed] [Google Scholar]
  4. Böhle A., Thanhäuser A., Ulmer A. J., Ernst M., Flad H. D., Jocham D. Dissecting the immunobiological effects of Bacillus Calmette-Guérin (BCG) in vitro: evidence of a distinct BCG-activated killer (BAK) cell phenomenon. J Urol. 1993 Dec;150(6):1932–1937. doi: 10.1016/s0022-5347(17)35941-4. [DOI] [PubMed] [Google Scholar]
  5. Catalona W. J., Hudson M. A., Gillen D. P., Andriole G. L., Ratliff T. L. Risks and benefits of repeated courses of intravesical bacillus Calmette-Guerin therapy for superficial bladder cancer. J Urol. 1987 Feb;137(2):220–224. doi: 10.1016/s0022-5347(17)43959-0. [DOI] [PubMed] [Google Scholar]
  6. Coe J. E., Feldman J. D. Extracutaneous delayed hypersensitivity, particularly in the guinea-pig bladder. Immunology. 1966 Feb;10(2):127–136. [PMC free article] [PubMed] [Google Scholar]
  7. Durek C., Rüsch-Gerdes S., Jocham D., Böhle A. Interference of modern antibacterials with bacillus Calmette-Guerin viability. J Urol. 1999 Dec;162(6):1959–1962. doi: 10.1016/S0022-5347(05)68078-0. [DOI] [PubMed] [Google Scholar]
  8. Harland S. J., Charig C. R., Highman W., Parkinson M. C., Riddle P. R. Outcome in carcinoma in situ of bladder treated with intravesical bacille Calmette-Guérin. Br J Urol. 1992 Sep;70(3):271–275. doi: 10.1111/j.1464-410x.1992.tb15730.x. [DOI] [PubMed] [Google Scholar]
  9. Herr H. W., Laudone V. P., Badalament R. A., Oettgen H. F., Sogani P. C., Freedman B. D., Melamed M. R., Whitmore W. F., Jr Bacillus Calmette-Guérin therapy alters the progression of superficial bladder cancer. J Clin Oncol. 1988 Sep;6(9):1450–1455. doi: 10.1200/JCO.1988.6.9.1450. [DOI] [PubMed] [Google Scholar]
  10. Jackson A. M., Alexandroff A. B., McIntyre M., Esuvaranathan K., James K., Chisholm G. D. Induction of ICAM 1 expression on bladder tumours by BCG immunotherapy. J Clin Pathol. 1994 Apr;47(4):309–312. doi: 10.1136/jcp.47.4.309. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Lamm D. L., Blumenstein B. A., Crawford E. D., Montie J. E., Scardino P., Grossman H. B., Stanisic T. H., Smith J. A., Jr, Sullivan J., Sarosdy M. F. A randomized trial of intravesical doxorubicin and immunotherapy with bacille Calmette-Guérin for transitional-cell carcinoma of the bladder. N Engl J Med. 1991 Oct 24;325(17):1205–1209. doi: 10.1056/NEJM199110243251703. [DOI] [PubMed] [Google Scholar]
  12. Lamm D. L., Blumenstein B. A., Crissman J. D., Montie J. E., Gottesman J. E., Lowe B. A., Sarosdy M. F., Bohl R. D., Grossman H. B., Beck T. M. Maintenance bacillus Calmette-Guerin immunotherapy for recurrent TA, T1 and carcinoma in situ transitional cell carcinoma of the bladder: a randomized Southwest Oncology Group Study. J Urol. 2000 Apr;163(4):1124–1129. [PubMed] [Google Scholar]
  13. Lamm D. L. Long-term results of intravesical therapy for superficial bladder cancer. Urol Clin North Am. 1992 Aug;19(3):573–580. [PubMed] [Google Scholar]
  14. Lamm D. L., Thor D. E., Harris S. C., Reyna J. A., Stogdill V. D., Radwin H. M. Bacillus Calmette-Guerin immunotherapy of superficial bladder cancer. J Urol. 1980 Jul;124(1):38–40. doi: 10.1016/s0022-5347(17)55282-9. [DOI] [PubMed] [Google Scholar]
  15. Lamm D. L., van der Meijden P. M., Morales A., Brosman S. A., Catalona W. J., Herr H. W., Soloway M. S., Steg A., Debruyne F. M. Incidence and treatment of complications of bacillus Calmette-Guerin intravesical therapy in superficial bladder cancer. J Urol. 1992 Mar;147(3):596–600. doi: 10.1016/s0022-5347(17)37316-0. [DOI] [PubMed] [Google Scholar]
  16. Lattime E. C., Gomella L. G., McCue P. A. Murine bladder carcinoma cells present antigen to BCG-specific CD4+ T-cells. Cancer Res. 1992 Aug 1;52(15):4286–4290. [PubMed] [Google Scholar]
  17. Lundholm C., Norlén B. J., Ekman P., Jahnson S., Lagerkvist M., Lindeborg T., Olsson J. L., Tveter K., Wijkstrom H., Westberg R. A randomized prospective study comparing long-term intravesical instillations of mitomycin C and bacillus Calmette-Guerin in patients with superficial bladder carcinoma. J Urol. 1996 Aug;156(2 Pt 1):372–376. doi: 10.1016/s0022-5347(01)65853-1. [DOI] [PubMed] [Google Scholar]
  18. Lutzeyer W., Rübben H., Dahm H. Prognostic parameters in superficial bladder cancer: an analysis of 315 cases. J Urol. 1982 Feb;127(2):250–252. doi: 10.1016/s0022-5347(17)53725-8. [DOI] [PubMed] [Google Scholar]
  19. Martínez-Piñeiro J. A., Jiménez León J., Martínez-Piñeiro L., Jr, Fiter L., Mosteiro J. A., Navarro J., García Matres M. J., Cárcamo P. Bacillus Calmette-Guerin versus doxorubicin versus thiotepa: a randomized prospective study in 202 patients with superficial bladder cancer. J Urol. 1990 Mar;143(3):502–506. doi: 10.1016/s0022-5347(17)40002-4. [DOI] [PubMed] [Google Scholar]
  20. Mathé G., Amiel J. L., Schwarzenberg L., Schneider M., Cattan A., Schlumberger J. R., Hayat M., De Vassal F. Active immunotherapy for acute lymphoblastic leukaemia. Lancet. 1969 Apr 5;1(7597):697–699. doi: 10.1016/s0140-6736(69)92648-8. [DOI] [PubMed] [Google Scholar]
  21. Merz V. W., Marth D., Kraft R., Ackermann D. K., Zingg E. J., Studer U. E. Analysis of early failures after intravesical instillation therapy with bacille Calmette-Guérin for carcinoma in situ of the bladder. Br J Urol. 1995 Feb;75(2):180–184. doi: 10.1111/j.1464-410x.1995.tb07307.x. [DOI] [PubMed] [Google Scholar]
  22. Millán-Rodríguez F., Chéchile-Toniolo G., Salvador-Bayarri J., Palou J., Vicente-Rodríguez J. Multivariate analysis of the prognostic factors of primary superficial bladder cancer. J Urol. 2000 Jan;163(1):73–78. doi: 10.1016/s0022-5347(05)67975-x. [DOI] [PubMed] [Google Scholar]
  23. Morales A., Eidinger D., Bruce A. W. Intracavitary Bacillus Calmette-Guerin in the treatment of superficial bladder tumors. J Urol. 1976 Aug;116(2):180–183. doi: 10.1016/s0022-5347(17)58737-6. [DOI] [PubMed] [Google Scholar]
  24. Oosterlinck W. The management of superficial bladder cancer. BJU Int. 2001 Jan;87(2):135–140. doi: 10.1046/j.1464-410x.2001.00948.x. [DOI] [PubMed] [Google Scholar]
  25. Pagano F., Bassi P., Milani C., Meneghini A., Maruzzi D., Garbeglio A. A low dose bacillus Calmette-Guerin regimen in superficial bladder cancer therapy: is it effective? J Urol. 1991 Jul;146(1):32–35. doi: 10.1016/s0022-5347(17)37707-8. [DOI] [PubMed] [Google Scholar]
  26. Prescott S., James K., Busuttil A., Hargreave T. B., Chisholm G. D., Smyth J. F. HLA-DR expression by high grade superficial bladder cancer treated with BCG. Br J Urol. 1989 Mar;63(3):264–269. doi: 10.1111/j.1464-410x.1989.tb05187.x. [DOI] [PubMed] [Google Scholar]
  27. Ratliff T. L., Gillen D., Catalona W. J. Requirement of a thymus dependent immune response for BCG-mediated antitumor activity. J Urol. 1987 Jan;137(1):155–158. doi: 10.1016/s0022-5347(17)43909-7. [DOI] [PubMed] [Google Scholar]
  28. Ratliff T. L., Kavoussi L. R., Catalona W. J. Role of fibronectin in intravesical BCG therapy for superficial bladder cancer. J Urol. 1988 Feb;139(2):410–414. doi: 10.1016/s0022-5347(17)42445-1. [DOI] [PubMed] [Google Scholar]
  29. Ratliff T. L., Ritchey J. K., Yuan J. J., Andriole G. L., Catalona W. J. T-cell subsets required for intravesical BCG immunotherapy for bladder cancer. J Urol. 1993 Sep;150(3):1018–1023. doi: 10.1016/s0022-5347(17)35678-1. [DOI] [PubMed] [Google Scholar]
  30. Rischmann P., Desgrandchamps F., Malavaud B., Chopin D. K. BCG intravesical instillations: recommendations for side-effects management. Eur Urol. 2000;37 (Suppl 1):33–36. doi: 10.1159/000052381. [DOI] [PubMed] [Google Scholar]
  31. Vegt P. D., Witjes J. A., Witjes W. P., Doesburg W. H., Debruyne F. M., van der Meijden A. P. A randomized study of intravesical mitomycin C, bacillus Calmette-Guerin Tice and bacillus Calmette-Guerin RIVM treatment in pTa-pT1 papillary carcinoma and carcinoma in situ of the bladder. J Urol. 1995 Mar;153(3 Pt 2):929–933. [PubMed] [Google Scholar]
  32. Zieger K., Wolf H., Olsen P. R., Hojgaard K. Long-term follow-up of noninvasive bladder tumours (stage Ta): recurrence and progression. BJU Int. 2000 May;85(7):824–828. doi: 10.1046/j.1464-410x.2000.00547.x. [DOI] [PubMed] [Google Scholar]
  33. Zieger K., Wolf H., Olsen P. R., Højgaard K. Long-term survival of patients with bladder tumours: the significance of risk factors. Br J Urol. 1998 Nov;82(5):667–672. doi: 10.1046/j.1464-410x.1998.00848.x. [DOI] [PubMed] [Google Scholar]

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