Complications of Intravesical BCG Immunotherapy for Bladder Cancer

Green, Daniel B.; Kawashima, Akira; Menias, Christine O.; Tanaka, Takashi; Redelman-Sidi, Gil; Bhalla, Sanjeev; Shah, Rakesh; King, Bernard F.

doi:10.1148/rg.2019180014

Cited by 73 publications

(65 citation statements)

References 81 publications

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“…Despite its demonstrated efficacy, BCG treatment presents with local adverse effects in more than 50% of patients, systemic adverse effects in around 30% of patients, and 1% to 5% of patients suffer rare but severe complications such as pulmonary infections or sepsis [ 14 , 15 , 16 , 17 ]. In fact, after transurethral resection of the tumor, there must be a delay of around two weeks before patients can proceed to IB BCG instillations, in order to avoid the systemic dissemination of the bacilli through the wound.…”

Section: Introductionmentioning

confidence: 99%

Mycolicibacterium brumae is a Safe and Non-Toxic Immunomodulatory Agent for Cancer Treatment

et al. 2020

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Intravesical Mycobacterium bovis Bacillus Calmette–Guérin (BCG) immunotherapy remains the gold-standard treatment for non-muscle-invasive bladder cancer patients, even though half of the patients develop adverse events to this therapy. On exploring BCG-alternative therapies, Mycolicibacterium brumae, a nontuberculous mycobacterium, has shown outstanding anti-tumor and immunomodulatory capabilities. As no infections due to M. brumae in humans, animals, or plants have been described, the safety and/or toxicity of this mycobacterium have not been previously addressed. In the present study, an analysis was made of M. brumae- and BCG-intravenously-infected severe combined immunodeficient (SCID) mice, M. brumae-intravesically-treated BALB/c mice, and intrahemacoelic-infected-Galleria mellonella larvae. Organs from infected mice and the hemolymph from larvae were processed to count bacterial burden. Blood samples from mice were also taken, and a wide range of hematological and biochemical parameters were analyzed. Finally, histopathological alterations in mouse tissues were evaluated. Our results demonstrate the safety and non-toxic profile of M. brumae. Differences were observed in the biochemical, hematological and histopathological analysis between M. brumae and BCG-infected mice, as well as survival curves rates and colony forming units (CFU) counts in both animal models. M. brumae constitutes a safe therapeutic biological agent, overcoming the safety and toxicity disadvantages presented by BCG in both mice and G. mellonella animal models.

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Section: Introductionmentioning

confidence: 99%

Mycolicibacterium brumae is a Safe and Non-Toxic Immunomodulatory Agent for Cancer Treatment

et al. 2020

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“…Additionally, BCG is also used for the treatment of bladder cancer. However, the reoccurrence often occurs after the treatment [13,14]. In this regard, apoptosis induction is one of the important mechanisms to defeat cancer progression [15].…”

Section: Discussionmentioning

confidence: 99%

Lactobacillus Acidophilus Cytotoxicity Effect and Apoptosis in Human Bladder Carcinoma Cells: An In Vitro Study

Taheri

Moazamian

Mahdavi

2021

Immuno

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Introduction: Anticancer effects of Lactobacillus acidophilus, as a probiotic bacterium, have been indicated in several studies. There are common therapeutic options for bladder cancer treatment; however, their side effects and recurrence of disease are considerable. Therefore, complementary medication is essential and it must be safe and effective. In the present research, we assessed the anti-tumor activity of Lactobacillus acidophilus (LB) on the bladder cancer cell line by evaluating the apoptosis mechanism. Materials and Methods: EJ138 bladder cancer cell line was provided and the cytotoxicity level of LB was evaluated with various concentrations after 24, 48, and 72 h. To evaluate the apoptosis effect, the gene expression of Bax, BCL2, and TNF-α was assessed using real-time PCR. Results: The optimum concentration of the cytotoxicity level was 12.5μg/mL at 24, 48, and 72 h. Bax expression was upregulated in tumor cells treated with LB alone and the mixture of LB and BCG (LB/BCG) as compared to the control group after 24 and 48 h. Also, the mRNA level of TNF-α increased in treated cells with LB and LB/BCG compared to the control group. BCL2 expression did not show a significant difference between experimental groups versus the control group. Conclusion: Our findings showed that LB has a synergistic effect with BCG through increasing apoptotic gene expression and TNF-α cytokine. Besides, at 48 h treatment, the apoptosis effect is more than 24 h. Thus, it seems that the mode of action of LB is time-dependent.

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“…Other mentioned rare complications consist of peritonitis, choroiditis, parotitis and a contaminated cardiac conduction gadget [51].…”

Section: Discussionmentioning

confidence: 99%

“…A major concern for such a patient with such signs and symptoms is whether to initiate an empirical anti-tubercular therapy or move ahead with biopsy for ascertaining diagnosis. This is based on one's personal scientific judgment and experience taking several factors along, giving due importance to severity of the complication, whether or not it is local or systemic and the invasiveness of the required biopsy procedure [51]. For mycotic pseudoaneurysm, spondylodiscitis or a reactivated infection, isolation of the infection source is preferred.…”

Section: Dilemmas and Uncertainitiesmentioning

confidence: 99%

Complications of intravesical BCG therapy in non-muscle invasive bladder cancer: our tertiary care centre experience

et al. 2020

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Background Urothelial bladder carcinoma accounts for around 3.9% cases of all the male cancers in India. Non-muscle-invasive bladder carcinoma (NMIBC) is predominant group which constitute approximately three fourth of the urothelial bladder cancer. Intravesical BCG immunotherapy is the corner stone of today’s NMIBC management. However, as with any other therapy it has its own complications and its interruption due to these adverse effects is a major cause of suboptimal efficacy. The aim of this study was to assess the complications of intravesical BCG therapy and their management in NMIBC patients. Methods This was a retrospective descriptive study conducted between October 2016 and November 2019; a backward review of 149 patients with diagnosis of NMIBC that undergone intravesicle BCG therapy was performed. Patient’s demographical, clinical, diagnostic and procedural data regarding bladder tumour, BCG therapy, its complications and management were collected and analysed. Results Total 149 patients were analysed, comprising 116 males and 33 females. The mean age was of 57.2 ± 6.7 years. Total 85.23% were primary and 14.76% were recurrent tumours. Total 96 patients (64.42%) completed the planned course, while 53 (35.57%) interrupted. The reasons for BCG interruption includes adverse effects (15.4%), progression of disease (6.7%), disease refractory to BCG (4.6%) and disease recurrence during BCG (3.3%). Most of the adverse events occurred in first 6 months and most interruptions occurred after the induction period. Cystitis was the most common observed adverse effect seen in 39.6% patients. Frequency, urgency, haematuria were common presentation. Radical cystectomy was the most common (16.10%) further treatment with patients whose treatment was interrupted. Conclusion BCG is an indispensable therapy available for NMIBC, but it is associated with array of adverse effects and complications, which are the main reasons for poor compliance to BCG therapy. Although BCG-related complications can affect any organ in the body, potentially life-threatening systemic BCG-related infections are encountered in only < 5% of patients. There are some difficulties in diagnosis of the BCG complications because acid-fast staining, culture and PCR test are not always positive; tissue biopsies should be indicated sometimes to evaluate histopathology and presence of M. bovis. A persistently monitored multidisciplinary approach with high index of suspicion and prompt anti-TB therapy can help to derive the maximum benefits while keeping the complications at check.

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Complications of Intravesical BCG Immunotherapy for Bladder Cancer

Cited by 73 publications

References 81 publications

Mycolicibacterium brumae is a Safe and Non-Toxic Immunomodulatory Agent for Cancer Treatment

Mycolicibacterium brumae is a Safe and Non-Toxic Immunomodulatory Agent for Cancer Treatment

Lactobacillus Acidophilus Cytotoxicity Effect and Apoptosis in Human Bladder Carcinoma Cells: An In Vitro Study

Complications of intravesical BCG therapy in non-muscle invasive bladder cancer: our tertiary care centre experience

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