From the Guidelines
BCG treatment primarily includes the intravesical instillation of BCG vaccine into the bladder to treat non-muscle invasive bladder cancer, with a standard regimen consisting of an induction course of six weekly instillations, followed by maintenance therapy. The treatment involves catheterizing the patient, draining the bladder, and instilling the BCG solution (typically 50-81 mg of BCG in 50 ml of saline), which is retained in the bladder for about 2 hours before voiding 1. Patients are advised to change position every 15 minutes to ensure the solution contacts all bladder surfaces.
The BCG therapy is commonly given once a week for 6 weeks, followed by a rest period of 4 to 6 weeks, with a full reevaluation at week 12 (ie, 3 months) after the start of therapy 1. Several meta-analyses demonstrate that BCG after TURBT is superior to TURBT alone or TURBT and chemotherapy in preventing recurrences of high-grade Ta and T1 tumors 1.
Some key points to consider when administering BCG treatment include:
- The importance of proper hydration before treatment and temporary avoidance of certain medications like aspirin or ibuprofen to minimize side effects
- The potential side effects of treatment, which may include urinary frequency, dysuria, hematuria, flu-like symptoms, and rarely, systemic BCG infection
- The need for patients to change position every 15 minutes during treatment to ensure the solution contacts all bladder surfaces
- The recommendation for full-dose BCG, although dose reduction may be used if there are substantial local symptoms during maintenance 1
Overall, BCG treatment is a highly effective therapy for non-muscle invasive bladder cancer, and its use is recommended as first-line treatment of high-risk NMIBC 1.
From the Research
BCG Treatment Overview
- BCG (Bacillus Calmette-Guerin) treatment is a form of intravesical therapy used to treat non-muscle invasive bladder cancer, specifically stage T1 grade 3 transitional cell carcinoma of the bladder 2.
- The treatment typically consists of a 6-week course of BCG instillations, followed by maintenance therapy consisting of intravesical instillations each week for 3 weeks given at specific intervals 2.
Comparison with Other Treatments
- BCG treatment has been compared to other treatments such as epirubicin (EPI) and mitomycin C (MMC) in various studies 3, 4, 5.
- A study found that BCG treatment was more efficacious than EPI in reducing tumor recurrence for Ta and T1 bladder cancer, but was associated with a higher incidence of adverse effects 3.
- Another study found that optimal MMC treatment was as effective as optimal BCG in intermediate-risk non-muscle invasive bladder cancer patients, reducing both recurrence and progression compared to non-optimal BCG 4.
Treatment Regimens
- The treatment regimen for BCG typically consists of a 6-week induction course, followed by maintenance therapy 2.
- The maintenance therapy regimen may vary, but typically consists of intravesical instillations each week for 3 weeks given at specific intervals 2.
- Other treatment regimens, such as sequential intravesical gemcitabine and MMC chemotherapy, have also been explored for patients with non-muscle invasive bladder cancer 6.
Efficacy and Safety
- BCG treatment has been shown to be effective in reducing tumor recurrence and progression in non-muscle invasive bladder cancer patients 2, 3, 4.
- However, BCG treatment is also associated with a higher incidence of adverse effects, such as drug-induced cystitis, haematuria, and systemic toxicity 3, 5.
- The safety and efficacy of BCG treatment compared to other treatments, such as MMC, are still being studied and debated 4, 5.