Preventing Progression and Improving Survival with BCG Maintenance

Lamm, Donald L.

doi:10.1159/000052376

Cited by 43 publications

(33 citation statements)

References 32 publications

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“…The progression rate for patients with CIS treated with intravesical BCG was reduced by 26%. The best results with BCG were found among patients treated with a maintenance regimen, which agrees with several other studies in the literature [22,25,26]. Based on these data it is becoming increasingly clear that BCG is the treatment of choice for patients with CIS.…”

Section: Intravesical Therapysupporting

confidence: 88%

Bladder cancer

Gwynn

Clark

2006

Current Opinion in Oncology

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The detection of bladder cancer continues to rely on direct visualization with cystoscopy. Efforts are underway to improve the utility of urinary markers and cystoscopy through fluorescence endoscopy. The management of superficial bladder cancer is based on transurethral resection of the tumor with perioperative intravesical instillation of chemotherapy strongly suggested for most patients. Risk stratifying patients with high-risk superficial bladder cancer remain a challenge and area of future research.

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Section: Intravesical Therapysupporting

confidence: 88%

Bladder cancer

Gwynn

Clark

2006

Current Opinion in Oncology

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“…It is therefore of interest that intravesical treatment of superficial carcinoma with BCG vaccine appears to reduce both disease recurrence and progression (Lamm, 2000). It may be that those patients with a high Ki-67 labelling index and COX-2 expression and a marked lymphocytic infiltration will have a better response to BCG (Alexandroff et al, 1999;O'Donnell, 2005).…”

Section: Discussionmentioning

confidence: 99%

The relationship between the systemic inflammatory response, tumour proliferative activity, T-lymphocytic infiltration and COX-2 expression and survival in patients with transitional cell carcinoma of the urinary bladder

et al. 2006

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The relationship between the systemic inflammatory response, tumour proliferative activity, T-lymphocytic infiltration, and COX-2 expression and survival was examined in patients with transitional cell carcinoma of the urinary bladder (n ¼ 103). Sixty-one patients had superficial disease and 42 patients had invasive disease. Cancer-specific survival was shorter in those patients with invasive compared with superficial bladder cancer (Po0.001). On univariate analysis, stratified by stage, increased Ki-67 labelling index (Po0.05), increased COX-2 expression (Po0.05), C-reactive protein (Po0.05) and adjuvant therapy (Po0.01) were associated with poorer cancer-specific survival. On multivariate analysis of these significant factors, stratified by stage, only C-reactive protein (HR 2.89, 95% CI 1.42 -5.91, P ¼ 0.004) and adjuvant therapy (HR 0.29, 95% CI 0.14 -0.62, P ¼ 0.001) were independently associated with poorer cancer-specific survival. These results would suggest that tumour-based factors such as grade, COX-2 expression or T-lymphocytic infiltration are subordinate to systemic factors such as C-reactive protein in determining survival in patients with transitional cell carcinoma of the urinary bladder.

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“…There are also recommendations to treat these patients with intravesical therapies such as BCG [15,16]. In fact, there is strong evidence that maintenance BCG is superior to induction BCG alone such that many patients will continue to get treatments at months 3 and 6 and then every 6 months [2,3,15]. The question that arises is how to use BLC within the appropriate window (490 d from BCG) and still continue monitoring every 3 months.…”

Section: Obstaclesmentioning

confidence: 99%

“…There are various strategies to reduce the risk of recurrence and progression. Intravesical therapies are intended to change the course of disease [2,3]. Single postoperative instillation of intravesical chemotherapy can reduce early recurrences especially in low-grade tumors by presumably killing shed cells at the time of TURBT [4].…”

Section: Introductionmentioning

confidence: 99%

Promises and challenges of fluorescence cystoscopy

Lotan

2015

Urologic Oncology: Seminars and Original Investigations

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Preventing Progression and Improving Survival with BCG Maintenance

Cited by 43 publications

References 32 publications

Bladder cancer

Bladder cancer

The relationship between the systemic inflammatory response, tumour proliferative activity, T-lymphocytic infiltration and COX-2 expression and survival in patients with transitional cell carcinoma of the urinary bladder

Promises and challenges of fluorescence cystoscopy

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