What is Bacillus Calmette-Guérin (BCG) maintenance therapy for bladder cancer?

Updated: Nov 12, 2019
  • Author: Gary David Steinberg, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

When induction is completed, a course of immunoprophylaxis or maintenance therapy is begun. Prolonging the course of therapy has been shown to reduce the frequency of recurrence and progression. These intervals have varied from instillations administered monthly to every 3 months or every 6 months. The optimum frequency and duration of this therapy seems to vary, but a Southwest Oncology study found that 2-3 instillations every 3 months is effective. [6]

Most experts agree that a maintenance program of at least 1 year is necessary. From the immunologic point of view, establishing this interval is difficult because patient variability is great and this is a biologic product whose dose may differ slightly with each instillation. The products also vary. Antigenic stimulation becomes greater with consecutive instillations but decreases dramatically when the stimulation is excessive.

Data from a small study conducted by Palou et al indicated that patients who are tumor-free after 6 months of therapy are likely to remain so indefinitely and do not need additional maintenance. [7] Most studies have shown the benefit of using maintenance therapy for at least one year.


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