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If theres a silver lining to the BCG situation, Fox said, its that theres growing evidence that smaller doses show efficacy in battling bladder cancers.
Indeed, to help prolong the supply of BCG, most urologists wind up dividing the dosage into thirds. There are studies, actually, that suggest that these lower doses are similarly effective in treating bladder cancer.
The Bladder Cancer Advocacy Network, a Maryland-based patient advocacy group, along with the American Urological Association and several other physician groups, have come up with treatment guidelines to help navigate the shortage. The suggestions include dividing up doses, and stopping maintenance therapy entirely, as was the case with Fields.
Dr. Karim Chamie, an associate professor of urology at University of California, Los Angeles, said the BCG shortage hasnt affected his practice just yet. But although the stockpile of BCG at UCLA is still in good shape, Chamie projects that will soon change.
Urologists in the community have already hit a shortage, and theyre referring their patients to me, Chamie said. So my clinics clogging up with patients who need BCG and they may be using some of the BCG I might have given someone else.
Highlighting The Value Of Genetic Modeling Of Bladder Cancer
Is genetic modeling of bladder cancer still useful in the postHuman Genome Project era? The answer is a resounding yes, according to NYU Langones Xue-Ru Wu, MD, the Bruce and Cynthia Sherman Professor of Urological Research and Innovation and vice chair of urological research, in a special supplement on bladder cancer published in 2020 in Clinical Cancer Research by the American Association for Cancer Research.
We need genetically tractable experimental systems more than ever to validate the biologic potential of combinatorial bladder tumor drivers, says Dr. Wu, whose research has helped illuminate how non-muscle-invasive bladder tumors form along the receptor tyrosine kinase RAS-PI3K signaling pathway. By interrogating the effects in mice of systematically deleting individual genes residing on chromosome 9p21, Dr. Wu demonstrated that common mutations must be accompanied by certain collaborative events in order for tumors to arise.
Genetic modeling is also key to better understanding the effects of lifestyle-associated carcinogens, such as tobacco and e-cigarette smoke, and environmental factors, including industrial chemicals found in many manufactured products, he says. In addition, scientists have an ongoing need for tools to evaluate novel diagnostic, treatment, and preventive strategies.
What Can I Expect Following Treatment
You may be advised to drink plenty of fluid to flush the rest of the medication from your bladder.
For six hours after each treatment, youll have to be very careful when you urinate to avoid transmitting BCG to others. Men should urinate while seated to avoid splashing.
Disinfect the urine by adding 2 cups of bleach into the toilet. Let it stand for about 20 minutes before flushing. You should also wash your genital area very carefully after you urinate, so your skin doesnt become irritated from the BCG. Wash your hands thoroughly, too.
Men can pass BCG to their partner during sex. For that reason, you should avoid sex for 48 hours after each treatment. Use a condom between treatments and for six weeks following your final treatment.
Women should avoid getting pregnant or breastfeeding while on BCG therapy.
Treatment is usually given every week for six weeks. After that, you might need to do it once a month for six months to a year.
One benefit of BCG is that while it affects the cells in your bladder, it doesnt have a major effect on any other part of your body. But there can be a few side effects such as:
- fever
When comparing BCG to other bladder cancer treatments, its important to remember that treatment isnt the same for everybody. Some of the factors that determine your options are:
- type of bladder cancer
- your age and general health
- how well you tolerate certain treatments
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What Happens During Bcg Cancer Treatment
Before beginning BCG treatment, local anesthesia is given to numb the area and keep you comfortable. Next, your healthcare provider will place a catheter into your urethra and inject the liquid BCG solution into your bladder.
The BCG solution needs to come in contact with cancer cells to kill them. So, once the medication is injected, your healthcare provider will remove the catheter and ask you to lie on your back, stomach and both sides for 15 minutes each.
When the process is complete, youre free to leave your appointment. However, you should avoid peeing for at least one more hour.
How long do you hold BCG in your bladder?
Once the BCG solution is injected into your bladder, youll hold it for a total of two hours. After this point, youll be able to pee.
What does BCG do to the bladder?
When the BCG solution enters your bladder, your immune system cells begin to attack the cancer cells in your bladder.
BCG treatment schedule
The initial BCG cancer treatment occurs weekly for six weeks. This is called induction therapy.
If the treatment is working, your doctor may prescribe BCG maintenance therapy. Maintenance therapy is given once a week for three weeks at the three-, six- and 12-month marks. For some people, this may be continued up to three years.
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There are about 80,000 new cases of bladder cancer in the U.S. each year, making it the nations sixth most prevalent cancer. About 20 percent of these cancers specifically, those with high-grade, non-muscle invasive disease can be treated with BCG. It doesnt work for everyone, but the response rate is more than 70 percent.
Standard treatment calls for clinicians to continue checking for cancer every three to six months after initial dosing, and administer follow-on doses of BCG to ensure the cancer remains in remission. Those are the kinds of doses that have remained out of reach for Field.
For him and other patients in similar circumstances, the consequences are as emotional as they are physical.
Donna Hoff, a 71-year-old retired bookkeeper, had her bladder tumors surgically removed, then was put on a regimen of BCG combined with interferon, another drug that boosts immune response. So far, the cancer has not come roaring back. But shes concerned that if her BCG maintenance treatment is abbreviated, it might.
Youre never really in remission, Hoff said. Its always sitting on your shoulder, waiting to return.
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Canadian Shortage Of Vital Bladder Cancer Drug Prompts Rationing
This article was published more than 7 years ago. Some information may no longer be current.
Canada is experiencing a serious shortage of an essential drug for the treatment of bladder cancer. The principal supplier of BCG for bladder cancer treatment is Merck Canada Inc., which sells it under the brand name OncoTICE.The Associated Press
Canada is experiencing a serious shortage of an essential drug for the treatment of bladder cancer.
The shortfall, which is due to manufacturing problems at plants operated by two different pharmaceutical companies, could have major consequences for patients.
Without the drug bacillus Calmette-Guérin strain tice to control their symptoms, some patients might require surgery to remove their bladders.
“We’re struggling with how to ration our stock,” Neil Fleshner, head of urology at University Health Network in Toronto, said in an interview.
“This shortage could last weeks or months and if we run out it will be a travesty.”
To ensure all patients get treatment despite dwindling stocks, Dr. Fleshner said they could be treated temporarily with one-third of the regular dose.
“There is some literature about this so getting one-third of a dose would be a minor compromise at least in the short-term.
“But going without BCG altogether would be an oncologic disaster,” he said.
The principal supplier of BCG for bladder cancer treatment is Merck Canada Inc., which sells it under the brand name OncoTICE.
Bcg And Safety At Home
- For the first six hours after BCG treatment, sit down on the toilet when urinating to avoid splashing. Pour 2 cups of household bleach into the toilet bowl. Wait 15 minutes before flushing and wipe the toilet seat with bleach.
- If you are wearing incontinence pads, take care when disposing of them. Pour bleach on the used pad, allow it to soak in, then place the pad in a plastic bag. Seal the bag and put it in your rubbish bin. You may be able to take it back to the hospital or treatment centre for disposal in a biohazard bin.
- If any clothing is splashed with urine, wash separately in bleach and warm water.
- For a few days after treatment, wash your hands extra well after going to the toilet, and wash or shower if your skin comes in contact with urine.
- Speak to your doctor or nurse if you have any questions.
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Certain chemotherapies, such as gemcitabine or mitomycin, can be used in lieu of BCG. But their efficacy pales in comparison, said Dr. Robert Svatek, chief of urologic oncology at University of Texas San Antonio.
Theres no question that BCG is more effective, Svatek said. Multiple trials have compared BCG to chemo, and every time it wins. It beats the chemo.
Patients can also elect a more extreme route: complete bladder removal surgery, or the construction of a bladder-like pouch made out of intestine. The costs of these complex surgeries are in the tens of thousands of dollars, and require years of follow-up treatment.
As effective as BCG may be, creating a safe strain of a live tuberculosis bacteria is rife with complications. The process, start to finish, takes about three months beginning with two months of horticulture. BCG is grown on a specific variety of potato, and that alone takes two months to grow. Once harvested, its brewed in giant vats over the course of a month. And plenty can go wrong.
Sometimes entire batches of drugs like BCG can get ruined if someone just pushes the wrong switch, or throws one wrong chemical into a big vat of the drug.
Ive seen that happen just a big mistake, somebody puts in the wrong chemical, and several million dollars worth of a drug has to be discarded, said Dr. Otis Brawley, a physician at Johns Hopkins and until recently the chief medical and scientific officer at the American Cancer Society.
How Should I Prepare For Bcg Treatment For Bladder Cancer
Prior to BCG treatment, your healthcare provider will give you a list of specific guidelines to help you prepare. In general, you should avoid caffeinated beverages and diuretics for four hours before your appointment. When you arrive for your procedure, you should pee to ensure that your bladder is empty.
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Before Taking This Medicine
You should not receive BCG intravesical if you are allergic to BCG, or if you have:
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tuberculosis
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a weak immune system from diseases such as AIDS, leukemia, or lymphoma
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a fever, a bladder infection, or blood in your urine
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if you are using steroids or receiving chemotherapy or radiation treatments or
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if you have had a bladder biopsy, surgery, or catheter within the past 14 days.
Tell your doctor if you have any type of bacterial, fungal, or viral infection .
It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.
You should not breastfeed while being treated with BCG.
Treating Complications Of Bcg Therapy
If you do experience a problem from BCG infection, you may need to receive targeted antibiotics, such as isoniazid and rifampin.
Complications of BCG therapy sometimes dont occur until years later. That can happen if the BCG bacteria that spread in the body become reactivated. These complications can sometimes be tricky to diagnose. Medical imaging might first make your clinician concerned about cancer or about another type of bacterial infection.
Make sure that all your medical care providers know that you have had BCG therapy. That will help guide their diagnostic process and ensure you get the best possible care. In some cases, your clinician will want a tissue sample from the involved area to make sure that the problem is from a BCG infection and not from some other source.
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Is There A Risk Of Bladder Cancer After Bcg Treatment
Like most cancers, bladder cancer can potentially return after treatment. Statistically, cancer will recur in up to 40% of people who receive BCG treatment. Its important to note, however, that even if the cancer comes back, it may not progress.
Low-grade bladder cancer usually doesnt spread to other areas of your body. But people who have low-grade bladder cancer have a higher risk of developing other low-grade cancers throughout their lifetime.
Less often, aggressive bladder cancer can develop after BCG treatment. If this happens, cystectomy is usually recommended.
Chemotherapy For Bladder Cancer
Chemotherapy uses anticancer drugs to destroy cancer cells. It is sometimes used to treat bladder cancer. Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of chemotherapy. You may also receive other treatments.
Chemotherapy is given for different reasons. You may have chemotherapy to:
- destroy cancer cells in the body
- shrink a tumour before other treatments such as surgery or radiation therapy
- destroy cancer cells left behind after surgery and reduce the risk that the cancer will come back
- make cancer cells more sensitive to radiation therapy
- relieve pain or control the symptoms of advanced bladder cancer
Chemotherapy for bladder cancer that has not grown into the muscle of the bladder wall is given as intravesical therapy, which means that the drugs are placed directly into the bladder. Chemotherapy may also be a systemic therapy given through a needle into a vein. This means that the drugs travel through the bloodstream to reach and destroy cancer cells all over the body, including those that may have broken away from the primary tumour in the bladder.
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Who Can Use Bcg
BCG is a treatment for early-stage bladder cancer that has not yet invaded the muscle of the bladder wall. Called non-muscle invasive bladder cancers or in situ bladder cancers, these account for about half of all bladder cancers.
For 2021, it was estimated that about 83,730 new cases of bladder cancer would be diagnosed in the United States, and about 17,200 American bladder cancer patients would die from the disease.
What To Expect Before Bcg Treatment
Before you are scheduled for BCG therapy, you will have to go through a screening test. This screening will determine whether you are eligible for BCG treatment or not. Factors considered during this screening test include the patients age, cancer type and stage, and overall health.
The doctor along with a radiation therapist will determine the best course of treatment for your condition and also ask you to avoid drinking too much fluid like water, juice, or caffeine.
If you are eligible, you will be given a date to schedule your treatment and will receive specific instructions on how to prepare. Once BCG is injected into the bladder, you will have to wait for 1-2 hours before urinating. This will allow the medicine to reach all the areas of the bladder.
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The success rate of bladder cancer treatment will vary depending on the age of the patient and the stage of the disease. Bladder cancer is a common and treatable disease, but bladder cancer treatment can be complex and challenging.
There are different treatment options available, each with different pros and cons. The best treatment option for you will depend on your situation and health.
We hope the information was helpful for you to understand what BCG treatment is, its symptoms, and what you can expect after the treatment. This method of treatment is considered a form of immunotherapy, which is an emerging form of cancer treatment.
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Mechanism Of Action Of Bcg
The mechanism of action of bacillus Calmette-Guérin therapy is incompletely understood. Some early studies purported that an immune response against BCG surface antigens cross-reacted with putative bladder tumor antigens, and this was proposed as the mechanism for the therapeutic effect of BCG however, multiple subsequent studies refute this claim.
The most likely mechanism of action of BCG immunotherapy involves a combination of its direct effect on tumor cells along with the patients immune response to the therapy. These effects are summarized by Kawai et al into three categories: infection of cancer cells, induction of immune response, and antitumor effects.
The infection of cancer cells is mediated by the glycoprotein fibronectin, which allows the internalization of BCG, breakdown of proteins, and cellular changes that trigger the immune system. This is similar to the immunologic reaction that occurs in patients with tuberculosis. This immune response comprises specific cellular changes including surface receptor changes and release of various cytokines. Interferon is considered to be an important part of this process and has been used in the past to determine appropriate response to treatment. The immune response crescendos to antitumor activity in which cells recognize the cancer cells, target them for destruction, and subsequently decrease cancer burden.
The overall response to BCG is limited if the patient is immunosuppressed.
Association Between Antibiotic Treatment And The Efficacy Of Intravesical Bcg Therapy In Patients With High
- 1Department of Urology, Center for Urologic Cancer, National Cancer Center, Goyang, South Korea
- 2Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
- 3Biometrics Research Branch, Research Institute, National Cancer Center, Goyang, South Korea
- 4Division of Tumor Immunology, Research Institute, National Cancer Center, Goyang, South Korea
- 5Department of Pathology, National Cancer Center, Goyang, South Korea
Objective: To investigate the association between antibiotic therapy and the efficacy of intravesical BCG therapy in patients with high-risk non-muscle invasive bladder cancer .
Methods: This study involved the retrospective review of medical records of patients who underwent transurethral resection of bladder tumors for high-risk NMIBC followed by intravesical BCG therapy between 2008 and 2017. Patients were categorized as none, short- , and long-course use based on the duration of antibiotic treatment concurrent with or initiated 30 days before BCG therapy. Oncologic outcomes, including recurrence-free survival and progression-free survival, were analyzed.
Long-course antibiotic treatment concurrently with or prior to intravesical BCG adversely influenced disease recurrence and progression outcomes in patients with high-risk NMIBC. Careful use of antibiotics may be required to enhance the efficacy of intravesical BCG therapy. Further mechanistic and prospective studies are warranted.
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