Urologic Survey (Urooncology)

Re: Side Effects of Bacillus Calmette-Guerin (BCG) in the Treatment of Intermediate- and High-Risk Ta, T1 Papillary Carcinoma ...


  • Tayyar Alp Özkan

J Urol Surg 2015;2(1):41-41

Since the first report on the use of intravesical BCG in 1976 the optimal dose and duration of treatment is controversial. The main concern on defining the optimal BCG dose is to have fewer side effects while keeping anti-tumor efficacy. Efficacy of 1/3 dose (1/3D) vs. full dose (FD) BCGwas previouslyreportedto be equalin the EORTC trial 30962 (1). The present study is addressing intravesical BCG side effects in this EORTC trial 30962. Aim of the present randomized prospective study was to determine whether reducing the dose or treatment duration was associated with fewer side effects. Four arms of the study consisted of 1/3D-1 year (n=341), FD-1 year (n=339), 1/3D-3 year (n=337) and FD- 3 year (n=338). Regarding intravesical BCG toxicity, neither reducing the dose (1/3D vs. FD) nor the treatment duration (1 year vs. 3 years) wassignificantly different from each other. NMIBC management with 1/3D of BCG was one of the recommendations because of current BCG supplementlimitations (2,3). It may be a reseanble option in this conjuncture but one should remember both 1/3D and FD have similar side effects and there is no advantage of using low dose BCG. SUGGESTED READING 1. Oddens J, Brausi M, Sylvester R, Bono A, van de Beek C, van Andel G, Gontero P, Hoeltl W, Turkeri L, Marreaud S, Collette S, Oosterlinck W. Final results of an EORTC-GU cancers group randomized study of maintenance bacillus Calmette-Guerin in intermediate- and high-risk Ta, T1 papillary carcinoma of the urinary bladder: one-third dose versus full dose and 1 year versus 3 years of maintenance. Eur Urol 2013;63:462-472. 2. Kassouf W. Approach for Consideration to Address Shortage of Bacillus Calmette-Guérin (BCG). 2014. https://bladdercancercanada.org/images/uploads/pdf/Approach_to_Address_BCG_Shortage__Sept_11,_2014_.pdf. Accessed 30.01.2015. 3. Mostafid AH, Palou Redorta J, Sylvester R, Witjes JA. Therapeutic Options in High-risk Non-muscle-invasive Bladder Cancer During the Current Worldwide Shortage of Bacille Calmette-Guerin. Eur Urol 2014;pii: S0302-2838:01214-7.