BCG: The Current Treatment of Choice for Bladder Cancer
Max Sherman, BSPharm
Published Online: September 1, 2007 - 12:00:00 AM (CDT)
History?Bladder Cancer
At the beginning of the 20th century, it became known that TB patients were less likely to contract cancer. Apparently the disease had an antitumor effect. An autopsy series by Raymond Pearl at Johns Hopkins Hospital in 1929 was one of the first reports that documented a lower frequency of cancer in patients with TB.3 The mechanism is unclear.
In the 1930s, the use of BCG as a cancer therapy was first raised, but there was little attention or enthusiasm during the 1950s and 1960s. Further research by Coe and Feldman rekindled interest, with the demonstration of a strong delayed hypersensitivity reaction to BCG in the guinea pig bladder.7
In 1976, Morales, Eidinger, and Bruce were the first to report on successful treatment of superficial bladder cancer with intravesical (within the bladder) BCG.8 They were able to demonstrate a remarkable decrease in the rates of recurrence in 9 patients. A randomized prospective trial by Donald Lamm and associates in 1980 confirmed these earlier observations.9
BCG is now regarded as the most successful urologic immunotherapy for treating cancer. It has become the treatment of choice for high-risk superficial bladder cancer in most countries, and it is given at an increasing annual rate of approximately 1 million doses.2
References
2. Bohle A, Sven B. Immune mechanisms in Bacillus Calmette Guerin immunotherapy for superficial bladder cancer. J Urol. 2003;170:964-969.
3. Meyer JP, Persad R, Gillatt DA. Use of bacille Calmette-Guerin in superficial bladder cancer. Postgrad Med J. 2002;78:449-454.
7. Coe JE, Feldman JD. Extracutaneous delayed hypersensitivity, particularly in guinea pig bladder. Immunology. 1966;10:127-136.
8. Morales A, Eidinger D, Bruce AW. Intracavity Bacille Calmette-Guerin in the treatment of superficial bladder tumors. J Urol.1976; 116:180-183.
9. Lamm DL, Thor DE, Harris SC, Reyna JA, Stogdill VD, Radwin HM. Bacille Calmette-Guerin immunotherapy of superficial bladder cancer. J Urol. 1980;124:38-40.