BCG
From Kidney Cancer Resource
Contents |
Overview
Bacillus Calmette-Guerin which abreviates to BCG is an intravesical treatment for Bladder Cancer based on BCG which is a form of immunotherapy is tuberculosis vaccine, has been shown to effectively eradicate CIS for 70% of patients also to retard recurrence and progression of TCC.
Details
Intravesical (within the bladder) BCG is one of the most commonly used immunotherapies used in bladder cancer treatment.
Bacillus Calmette-Guerin (BCG) is the vaccination used to protect against tuberculosis (TB), yet when administered into the bladder is thought to provoke an immune response.
The intravesical BCG, an inactivated form of the bacterium Mycobacterium tuberculosis, is administered via catheter directly into the bladder where it remains for two hours. The immune response is successful in reducing the recurrence of bladder cancer, possibly by destroying any remaining cancer cells.
How does it work?
Immunotherapies work by creating a reaction within the body's immune system that works to restore or boost the body's natural immune defence.
How exactly immunotherapies work to destroy cancer and reduce the possibility of recurrence is relatively unknown apart from the known response from the body's immune system.
Intravesical BCG immunotherapy is used for high grade tumours, often in patients with multiple or recurrent tumours. Treatment with intravesical BCG has shown to delay progression to the muscles or/and metastatic disease, preserve the bladder and decrease the possibility of death from bladder cancer.
The intravesical BCG treatment
This treatment is performed in an outpatient setting generally and involves the insertion of a catheter and the administration of BCG directly in to the bladder. To administer the BCG vaccine, the bladder must be completely empty, therefore patients are recommended to restrict fluid intake for 8-12 hours and have no fluid for 4 hours before the treatment.
The BCG vaccine in combination with saline is infused through the catheter into the bladder in combination with a vaccine through the skin. The BCG solution must remain in direct contact with the bladder for two hours. When emptying the bladder, you must avoid direct skin contact both during and after urinating, as the solution may cause skin irritation or a rash. The bladder must be completely emptied, with men being advised to sit while urinating to avoid splashing. Afterwards the genital area as well as the hands must be thoroughly cleansed and washed.
As this treatment uses live bacteria, the possibility of contamination means the toilet must be neutralized. This can be done by pouring two cups (or a pint) of neat bleach into the toilet and letting it stand for 15-20 minutes before flushing. The bladder should be thoroughly flushed after the treatment by increasing fluid intake.
Side Effects
Most patients do not experience any side effects, but a proportion do suffer some mild side effects.
These side effects include:
Approximately 2 out of 3 people experience an irritated bladder from the solution, which is similar to a urinary tract infection (UTI). Some feel they want to pass more urine than usual. If you experience any of the below side effects it is recommended you contact your doctor:
Flu-like symptoms.
Increased fatigue.
Blood or clots in the urine (haematuria).
Frequent or persistent cough.
Post-treatment precautions
Sex: Men who receive the intervesical BCG treatment can infect their partners during sex with BCG. It is recommended that you should not have sex 48 hours after each treatment. A condom is advised for sex during the six week period and it is recommended that a condom is used six weeks after the treatment has ended.
Risks
Being administered BCG vaccine does not mean you are infected with tuberculosis. There are risks associated with BCG treatment, approximately 1 in 1000 develop significant local reaction and contraction of tuberculosis, a potentially fatal and very infectious disease, develops in fewer than one in a million. Intravesical BCG treatment requires an experienced medical professional to administer the treatment, as patients need to be selected with a particular set of criteria in mind to ensure that they are healthy enough for the vaccine.
This treatment is used for the following diseases:
Transitional Cell Carcinoma of the Bladder
Squamous Cell Carcinoma of the Bladder
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Articles
Intravesical Bacillus Calmette-Guerin therapy prevents tumor progression and death from superficial bladder cancer: ten-year follow- up of a prospective randomized trial HW Herr, DM Schwalb, ZF Zhang, PC Sogani, WR Fair, WF Whitmore Jr and HF Oettgen Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
PURPOSE:
Superficial bladder tumors (stage Ta, T1, and Tis) may progress to invade the bladder muscle and cause death from metastatic cancer. Transurethral tumor resection (TURB) is the standard therapy for such tumors, but surgery alone may not prevent tumor progression. Intravesical therapy is widely used as an adjunct to TURB. Bacillus Calmette-Guerin (BCG) is the most active intravesical agent, but whether BCG prevents tumor progression and death from bladder cancer is unknown.
PATIENTS AND METHODS:
Between 1978 and 1981, 86 high-risk patients with superficial bladder cancer were randomly assigned to receive either TURB (n = 43) or TURB plus BCG (n = 43). Adverse tumor features for progression were equally distributed between the two groups. BCG was administered weekly for 6 weeks. Patients were evaluated every 3 to 6 months thereafter for progression to muscle invasion or metastasis. Control (TURB) patients with recurrent superficial tumors were eligible for crossover to the BCG arm. All patients have been monitored until event or for a minimum of 10 years (range, 10 to 14).
RESULTS:
The 10-year progression-free rate was 61.9% (95% confidence interval [CI], 47.2% to 76.7%) for patients treated with BCG and 37% (95% CI, 22.9% to 53.1%) for control patients. The median progression-free interval was not reached for the BCG group and was 46 months for the control group (P = .0063). Of 18 control patients crossed over to BCG (median, 29 months), 15 did not show tumor progression. TURB plus BCG resulted in a 10-year disease-specific survival rate of 75%, compared with 55% with TURB alone (P = .03).
CONCLUSION:
This study shows that intravesical therapy with BCG delays tumor progression and death from tumor in patients who present with superficial bladder cancer.
To view the original of this article from Journal of Clinical Oncology, Vol 13, 1404-1408 Click Here
Articles
UroToday (BC) 04-Apr-08-03
- EAU 2008 - Prognostic Factors in Patients with Intermediate and High Risk Stage Ta T1 Papillary Carcinoma of the Bladder Treated with Maintenance Epirubicin or Maintenance Bacillus Calmette-Guerin
20-Dec-2007 - BCG
- History of Bacillus Calmette-Guerin and Bladder Cancer: An Immunotherapy Success Story - Abstract
21-Dec-2007 - BCG
- Cathepsin B is Involved in the Apoptosis Intrinsic Pathway Induced by Bacillus Calmette-Guérin in Transitional Cancer Cell Lines
References
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