Immunotherapy

Intravesical Bacille Calmette–Guérin (BCG) therapy after removal of prominent bladder tumor masses by transurethral resection is aimed to prevent recurrence of bladder cancer and to reduce disease progression to muscle-invasive bladder cancer. The indication of BCG therapy is high-grade Ta, T1, and/or carcinoma in situ, and multifocal, large, low-grade Ta or recurrent low-grade Ta tumors. BCG is administered directly into the bladder at weekly intervals for an initial course of 6–8 weeks with 81 mg or 27 mg of BCG. Greater reduction in recurrences can be obtained by using maintenance courses of three instillations at three monthly, then six monthly intervals with a recommended dosing of 27 mg BCG for at least 1 year. BCG, however, has more toxicity and systemic side effects that can be life threatening than other cytotoxic agents, causing many patients to discontinue treatment. The results of BCG usually need to be assessed by repeat biopsies.