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- is used in the treatment of superficial TCC and may help to decrease
the rate of recurrence and progression.
- BCG immunotherapy is the most effective intravesical therapy and involves
a live attenuated strain of Mycobacterium bovis. Some early studies
purported that an immune response against BCG surface antigens cross-reacted
with putative bladder tumor antigens, and this was proposed as the mechanism
for the therapeutic effect of BCG; however, multiple subsequent studies
refute this claim and demonstrate that BCG induces a nonspecific,
cytokine-mediated immune response to foreign protein.
- Because BCG is a live attenuated organism, it can cause an acute
disseminated tuberculosislike illness if it enters the bloodstream (BCG
sepsis), possibly resulting in death. Therefore, the use of BCG is
contraindicated in patients with gross hematuria.
- BCG typically causes mild systemic symptoms that resolve within 24-48
hours after intravesical instillation. BCG also can cause granulomatous
cystitis or prostatitis with bladder contraction.
- BCG is recommended for CIS, T1 tumors, and high-risk Ta tumors (large,
high-grade, recurrent, or multifocal tumors). This therapy is less effective
in reducing the 5-year recurrence rate for low-grade and low-stage TCC (see
Table 1).
- Typically, BCG is administered weekly for 6 weeks. Another 6-week course
is administered if a repeat cystoscopy reveals tumor persistence or
recurrence. Recent evidence indicates that maintenance therapy with a weekly
treatment for 3 weeks every 6 months for 1-3 years may provide more lasting
results.
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