Document Detail


Optimal BCG treatment of superficial bladder cancer as defined by American trials.
MedLine Citation:
PMID:  1396941     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Immunotherapy provides an effective alternative approach to chemotherapy in the management of superficial bladder cancer. The first widely used immunotherapy, bacillus Calmette-Guérin (BCG), eradicates residual tumour bacillus Calmette-Guérin (BCG), eradicates residual tumour in one half of patients with carcinoma in situ. Unlike chemotherapy, induction of immunity against transitional cell carcinoma has the potential of protecting patients from tumours which have not yet developed. Controlled trials suggest that BCG immunotherapy reduces disease progression, decreases the need for cystectomy and prolongs survival. While the optimal BCG treatment schedule remains unknown and may in fact vary from one patient to another, data clearly suggest that a single 6-week induction course is suboptimal. In 150 randomized patients with CIS treated with 120 mg Connaught BCG, Southwest Oncology Group (SWOG) investigators found that just 3 additional weekly treatments at week 12 increased complete response from 70 to 82% (p less than 0.05). Intravesical BCG is clearly superior to oral BCG, and controlled studies have demonstrated that percutaneous administration is not necessary. While evidence suggests that BCG is the best available treatment for superficial bladder cancer and 95% of patients have no significant toxicity, serious and even fatal toxicity can occur. Sepsis can occur with intravenous absorption and often appears to result from hypersensitivity. Limited clinical and animal model experience suggests that cycloserine improves survival over treatment with isoniazid and rifampicin, but optimal treatment of BCG sepsis is isoniazid 300 mg, rifampicin 600 mg, and prednisolone 40 mg daily.
Authors:
D L Lamm
Publication Detail:
Type:  Comparative Study; Journal Article; Review    
Journal Detail:
Title:  European urology     Volume:  21 Suppl 2     ISSN:  0302-2838     ISO Abbreviation:  Eur. Urol.     Publication Date:  1992  
Date Detail:
Created Date:  1992-10-29     Completed Date:  1992-10-29     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7512719     Medline TA:  Eur Urol     Country:  SWITZERLAND    
Other Details:
Languages:  eng     Pagination:  12-6     Citation Subset:  IM    
Affiliation:
West Virginia University, Morgantown.
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MeSH Terms
Descriptor/Qualifier:
Administration, Intravesical
Administration, Oral
BCG Vaccine / administration & dosage*
Carcinoma in Situ / drug therapy,  surgery,  therapy*
Carcinoma, Transitional Cell / drug therapy,  surgery,  therapy*
Dose-Response Relationship, Immunologic
Doxorubicin / therapeutic use
Drug Administration Schedule
Humans
Neoplasm Recurrence, Local
Prospective Studies
Randomized Controlled Trials as Topic
Thiotepa / therapeutic use
Urinary Bladder Neoplasms / drug therapy,  surgery,  therapy*
Chemical
Reg. No./Substance:
0/BCG Vaccine; 23214-92-8/Doxorubicin; 52-24-4/Thiotepa

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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