What is the role of Bacillus Calmette-Guérin in bladder carcinoma in situ treatment?

Updated: Oct 24, 2019
  • Author: Stanley A Brosman, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Bacillus Calmette-Guérin (BCG) is the most common intravesical agent used to treat carcinoma in situ (CIS). [2, 3] Approximately 70% of patients have an initial response to BCG vaccine. Rates of tumor progression vary according to the particular study, but more than 75% of patients who initially have a complete response remain disease free for more than 5 years. This is equivalent to 45-50% of those who initially respond. At 10 years, approximately 30% of patients with CIS who are treated with BCG are disease free.

A failure to respond to BCG vaccine may be defined as persistent or recurrent tumor when a BCG vaccine reaction is evident. If this occurs within the course of a year, an alternative strategy is to combine BCG with interferon-alfa (IFN-alfa). In this situation, 50 million units of IFN-alfa can be instilled into the bladder, with the BCG vaccine administered 1 hour later. The IFN-alfa up-regulates the major histocompatibility complex/BCG vaccine antigen complex, which enhances the immunologic response.

With this combination, doses of BCG vaccine as small as one tenth of a vial have been shown to be effective. IFN-alfa is well tolerated, and the lower doses of BCG vaccine are usually associated with decreased adverse effects.

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