Bladder Cancer Treatment With TB Vaccine

Andrew Siegel MD  4/22/17

The use of tuberculosis vaccine (a.k.a. bacillus Calmette-Guerin or BCG) to treat bladder cancer is one of the great success stories in the history of using the immune system to combat cancer. For 40 years, BCG has been recognized as the standard of care for high-grade, superficial bladder cancer and carcinoma-in-situ (CIS), a flat but high-grade bladder cancer. The use of BCG is responsible for significantly reducing bladder cancer progression and recurrence.

Image above: BCG in powdered form that needs to be reconstituted

Image above: Typical appearance of a superficial bladder cancer

 

Bladder cancer has a strong tendency to recur, despite cystoscopy-guided complete removal of visible tumors (using a “telescope” placed within the bladder via the urethra). This approach can only treat obvious and visible tumors, with the real possibility that there are additional tumors present that are not yet visible (microscopic), since bladder cancer is a “field” disease—capable of occurring anywhere within the bladder lining. One of the rationales for using a medication like BCG is that it is a liquid formulation that is instilled in the bladder and will bathe all inner surfaces of the bladder. I often use the analogy of plucking out dandelions in your lawn individually as opposed to using a weed spray with respect to the difference between bladder tumor resection (cystoscopic surgical removal) and using a BCG-like medication.

A Brief History of BCG

BCG is a unique strain of “weakened” mycobacterium bovis (cow tuberculosis bacterium) developed by Albert Calmette and Camille Guerin at the Pasteur Institute in Lille, France in 1921 as a tuberculosis vaccine. At the time of its development, there was a growing recognition of the relationship between the immune system and cancer. In 1929, it was discovered that BCG might also have a role in the treatment of cancer when autopsy findings in TB patients were correlated with a reduced prevalence of cancers. Early investigators found that mice given BCG were protected against cancers that were implanted. In 1975, Dr. Jean deKernion at UCLA reported a melanoma that had spread to the bladder that was eliminated by direct injection of BCG into the melanoma. In 1976, Alvaro Morales successfully instilled BCG inside the bladder to treat bladder cancer and after clinical trials it was FDA approved for use within the bladder in 1990…The rest is history.

How It Works

BCG activates the immune system and triggers an inflammatory response that destroys bladder cancer cells. A good response to BCG immunotherapy requires a patient with an immune system capable of mounting a cellular immune response. It is accomplished by infusing a sufficient quantity of BCG so that it has direct contact with cancer cells.

How It Is Used

BCG is instilled directly within the urinary bladder.  One cycle is a once per week treatment for 6 weeks.  A full course is two cycles, followed by maintenance therapy. Typically the BCG treatment is initiated two weeks or so following the bladder tumor resection to allow the bladder time to heal. BCG is placed inside the urinary bladder using a narrow catheter. Retaining it for two hours is ideal and rotating body position is important so that all areas of the bladder are adequately bathed with the BCG.

Side Effects of BCG

Low-grade fever, urinary urgency, frequency, burning and blood in the urine are typical symptoms, often indicative of the immune response being mounted.   Occasionally, flu-like symptoms may occur, including fever, chills, cough, muscle and joint aches. When severe symptoms occur, BCG concentration can be reduced to 1/3, 1/10, 1/30, or even 1/100^th of a dose to prevent escalating side effects.

 Tips For Patients Receiving BCG

• Avoid drinking any fluids for at least 2 hours and avoid caffeine-containing products for at least 4 hours prior to bladder instillation in order to be able to retain the BCG for a full 2 hours after the instillation and to avoid diluting the concentration of the BCG.
• Rotate your body in order to bathe all surface areas of the bladder with the BCG (supine, left, right, prone).
• Care should be used when urinating after the BCG is instilled to avoid contaminating one’s hands or genitals with the BCG. Men should sit to urinate to reduce the likelihood of self-contamination. Hands and genitals should be thoroughly washed afterwards, and household bleach should be added to the toilet immediately after urination. The bleach should stand for 15 minutes before flushing to deactivate the BCG.

Wishing you the best of health,

http://www.AndrewSiegelMD.com

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Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com

YouTube site: http://www.YouTube.com/incontinencedoc

Vidscrip site (for short educational videos): http://www.Vidscrip.com/andrewsiegel

Tags: Andrew Siegel MD, bacillus calmette-guerin, BCG, bladder cancer, immunotherapy, tuberculosis, tuberculosis vaccine, urothelial cancer