Nonspecific Immunotherapy with BCG Vaccine in Bladder Tumors

BCG Vaccine in Superficial Bladder Tumours: Eight Years Later

“…The preliminary results of a study initiated in our ser vice in 1975 to evaluate BCG vaccine in patients with superficial bladder carcinoma suggested that it could be effective both for the treatment and prevention of this type of tumour [1], A further report provided more evi dence on the efficacy of BCG, particularly when used intravesically [2], thus confirming the favourable results obtained initially by Morales et al [3] in 1976. Since then, multiple studies [4][5][6][7][8][9][10] have also proved that BCG immunotherapy can favourably influence the natural his tory of low grade/stage bladder carcinoma.…”

“…A positive purified protein derivative response seems to be necessary for maximum BCG anti tumour activity [4,6,15], suggesting that its effectiveness might be nonspecific and results from a delayed hyper sensitivity reaction more than from a response against specific tumour antigens [15]. The superiority of instilla tions, particularly in patients presenting bladder irritabil ity symptoms, as well as the presence of inflammatory lesions [1,4,6] seem to indicate that the inflammatory local response is an essential part of the anti-tumour action of BCG and that this activity represents the by product of nonspecific reaction. It is, however, also pos sible that, stimulated by BCG, lymphocytes and macro phages may inhibit the growth of tumour cells by direct contact or by the release of tumouricidal factors [4], Three kinds of BCG strains have been used for the clinical studies mentioned in this article: lyophilized Pas teur strain BCG [1,2,4,10], Institute Armand Frappier [3,5] and Tice strain [6], with apparently similar benefi cai effects.…”

“…Although bladder instillations seem to be doserelated and a safer route of administration than direct tumour injection [1,2] and dermal scarifications, it is of paramount importance to explore different regimes and routes further, aiming to increase the therapeutic effec tiveness, to minimize side effects and to find the most adequate duration of therapy. In this sense, the use of inactivated BCG by heat or irradiation, or the routine treatment of all patients with isoniazide, which in labora tory experiments [ 17] has been able to preserve the bene fits of BCG lessening the side effects, would seem appropropriate measures.…”

Use of Intravesical Bacillus Calmette-Guérin in the Treatment of Superficial Transitional Cell Carcinoma of the Bladder: An Overview

“…Many variables in patient selection and treatment program made it impos sible to estimate the value of this route of administra tion, although antitumor effect was observed [28,29].…”

“…Second, intralesional administration has been abol ished after it was used in 2 patients, of whom 1 patient developed a serious hypersensitivity reaction, resulting in an allergic shock [28,29], Rosenberg et al [30] observed widespread interstitial granulomas in lungs, liver, bone marrow, spleen and heart, found at postmor tem in patients who received intratumoral Glaxo BCG immunotherapy for prostatic carcinoma. Although these lesions were usually asymptomatic, they were observed to persist for months after immunotherapy [31].…”