BCG-therapy for non-muscle-invasive bladder cancer: overview of the current trends
- Authors: Dymov A.M.1, Lee Y.A.1, Korchagin M.P.2,3, Dzharimok A.R.4, Vinarov A.Z.1, Gazimiev M.A.1
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Affiliations:
- Institute for Urology and Human Reproductive Health of FGAOU I.M. Sechenov First Moscow State Medical University
- GBUZ “MNPC for the fight against tuberculosis DZM”
- FGBOU VO “Russian University of Medicine”
- Medical Institute of Maykop Technological University
- Issue: No 2 (2024)
- Pages: 116-120
- Section: Considerations
- URL: https://journals.eco-vector.com/1728-2985/article/view/633621
- DOI: https://doi.org/10.18565/urology.2024.2.116-120
- ID: 633621
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Abstract
Introduction. Recurrence of non-muscle-invasive bladder cancer (NMIBC) occurs in 70% of cases, and the risk of progression to muscle-invasive bladder cancer is 20%. Intravesical BCG therapy is indicated in order to increase relapse-free survival in patients with intermediate and high-risk NMIBC. We carried out a survey of Russian urologists on the use of intravesical BCG therapy in the treatment of NMIBC, and also presented the regulatory framework for the use of BCG for the treatment of bladder cancer.
Aim. To evaluate the use of intravesical BCG therapy among urologists of the Russian Society of Urology.
Results. According to the results of a survey of 145 urologists, 46 (32%) do not prescribe BCG therapy to patients with NMIBC. Most of them (63%) have more than 10 years of experience. The main reasons why urologists do not recommend BCG therapy are the lack of conditions (74%), an absence of the drug (20%), fear of adverse reactions or development of tuberculosis infection of themselves and medical staff (2%), absence of recommendations for BCG therapy from an oncological dispensary (2%). The most commonly prescribed drugs for intravesical instillation areImuron-vac (69%), Uro-BCG-medac (29%), OncoTICE BCG (2%). Only 8% of doctors did not report difficulties during therapy. The most common reason for the refusing from BCG therapy was the lack of conditions in the medical facilities.
Conclusions. According to the survey, one third of doctors do not prescribe BCG therapy due to the lack of conditions or a shortage of the drug. An increase of relapse-free survival of patients with NMIBC is possible by providing conditions for intravesical immunotherapy.
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About the authors
A. M. Dymov
Institute for Urology and Human Reproductive Health of FGAOU I.M. Sechenov First Moscow State Medical University
Author for correspondence.
Email: alimdv@mail.ru
Ph.D., MD
Russian Federation, MoscowYu. A. Lee
Institute for Urology and Human Reproductive Health of FGAOU I.M. Sechenov First Moscow State Medical University
Email: julee1806@gmail.com
student
Russian Federation, MoscowM. P. Korchagin
GBUZ “MNPC for the fight against tuberculosis DZM”; FGBOU VO “Russian University of Medicine”
Email: mihailsun@mail.ru
GBUZ “MNPC for the fight against tuberculosis DZM”, Department of Urology of FGBOU VO “Russian University of Medicine”
Russian Federation, Moscow; MoscowA. R. Dzharimok
Medical Institute of Maykop Technological University
Email: a.dzharimok@yandex.ru
Ph.D., urologist
Russian Federation, Maykop, Republic AdygeaA. Z. Vinarov
Institute for Urology and Human Reproductive Health of FGAOU I.M. Sechenov First Moscow State Medical University
Email: avinarov@mail.ru
Ph.D., MD, urologist
Russian Federation, MoscowM. A. Gazimiev
Institute for Urology and Human Reproductive Health of FGAOU I.M. Sechenov First Moscow State Medical University
Email: gazimiev_m_a@staff.sechenov.ru
Ph.D., MD, urologist
Russian Federation, MoscowReferences
- Saluja M., Gilling P. Intravesical bacillus Calmette-Guérin instillation in non-muscle-invasive bladder cancer: A review. Int J Urol. 2018;25(1):18–24.
- Kamat A.M. et al. Expert consensus document: Consensus statement on best practice management regarding the use of intravesical immunotherapy with BCG for bladder cancer. Nat Rev Urol. 2015;12(4):225–235.
- Malmström P.U. et al. An individual patient data meta-analysis of the long-term outcome of randomised studies comparing intravesical mitomycin C versus bacillus Calmette-Guérin for non-muscle-invasive bladder cancer. Eur Urol. 2009;56(2):247–256.
- Schmidt S. et al. Intravesical Bacillus Calmette-Guérin versus mitomycin C for Ta and T1 bladder cancer. Cochrane Database Syst Rev. 2020;1(1).
- Sylvester R.J. et al. Long-term efficacy results of EORTC genito-urinary group randomized phase 3 study 30911 comparing intravesical instillations of epirubicin, bacillus Calmette-Guérin, and bacillus Calmette-Guérin plus isoniazid in patients with intermediate- and high-risk stage Ta T1 urothelial carcinoma of the bladder. Eur Urol. 2010;57(5):766–773.
- Duchek M. et al. Bacillus Calmette-Guérin is superior to a combination of epirubicin and interferon-alpha2b in the intravesical treatment of patients with stage T1 urinary bladder cancer. A prospective, randomized, Nordic study. Eur Urol. 2010;57(1):25–31.
- Sylvester R.J., Van der Meijden A.P.M., Lamm D.L. Intravesical bacillus Calmette-Guerin reduces the risk of progression in patients with superficial bladder cancer: a meta-analysis of the published results of randomized clinical trials. J Urol. 2002;168(5):1964–1970.
- Jakse G. et al. Intravesical BCG in patients with carcinoma in situ of the urinary bladder: long-term results of EORTC GU Group phase II protocol 30861. Eur Urol. 2001;40(2):144–150.
- Takenaka A. et al. Clinical outcomes of bacillus Calmette-Guérin instillation therapy for carcinoma in situ of urinary bladder. Int J Urol. 2008;15(4):309–313.
- Chamie K. et al. Compliance with guidelines for patients with bladder cancer: variation in the delivery of care. Cancer. 2011;117(23):5392–5401.
- Angelidou A. et al. Licensed Bacille Calmette-Guérin (BCG) formulations differ markedly in bacterial viability, RNA content and innate immune activation. Vaccine. Elsevier Ltd. 2020;38(9):2229–2240.
- Глыбочко П.В., Фисенко В.П. Иммунотерапия рака мочевого пузыря. Вакцина БЦЖ: принципы действия, эффективность и безопасность. Экспериментальная и клиническая фармакология. 2016;79(10):34–43.
- Larsen E.S. et al. Bacillus Calmette-Guérin immunotherapy for bladder cancer: a review of immunological aspects, clinical effects and BCG infections. APMIS. 2020;128(2).
- Brandau S. et al. Nk cells are essential for effective BCG immunotherapy. Int J Cancer. 2001;92(5):697–702.
- Goletti D. et al. Update on tuberculosis biomarkers: From correlates of risk, to correlates of active disease and of cure from disease. Respirology. Respirology. 2018;23(5):455–466.
- Goletti D., Sanduzzi A., Delogu G. Performance of the tuberculin skin test and interferon-γ release assays: an update on the accuracy, cutoff stratification, and new potential immune-based approaches. J Rheumatol. 2014;91(Suppl. 91):24–31.
- Nagai T. et al. Evaluation of the Dwell-Time and Dose Difference in Intravesical Bacillus Calmette-Guèrin Therapy. Asian Pac J Cancer Prev. Shahid Beheshti University of Medical Sciences. 2019;20(5):1389.
- Andius P., Fehrling M., Holmäng S. Intravesical bacillus Calmette-Guèrin therapy: experience with a reduced dwell-time in patients with pronounced side-effects. BJU Int. John Wiley & Sons, Ltd, 2005;96(9):1290–1293.
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