Toxicity of intravesical BCG and its management in patients with superficial bladder tumors

Eduardo Orihuela, H. W. Herr, C. M. Pinsky, W. F. Whitmore

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

Toxicity of bacillus Calmette-Guerin (BCG) Pasteur strain, given in a dose of 120 mg once a week for 6 weeks, was retrospectively evaluated in a study of 107 patients with recurrent superficial bladder cancer. Only six patients had no symptoms of toxicity. Severe crystitis (ten patients) was most likely to occur in those with decreased bladder compliance before treatment. Systemic symptoms resembling those of influenza (flu) were severe in six patients. Potentially serious complications occurred in six patients. Overall, toxic reactions were mild and self limited, and toxicity often could be easily managed by a reduction in the BCG dose (17 patients), temporary interruption of treatment (five patients), or cessation (four patients). Late occurrence of bladder granulomas (32 patients) and cytoscopic appearance of significant cystitis (55 patients) did not correlate with posttreatment voiding symptoms, and these changes were temporary and confined to the first 6 months after treatment. There were no cases of late bladder contracture, and none of the patients free of voiding symptoms before treatment had such symptoms afterward. Extravesical granulomas were observed in 37 patients and were the cause of obstruction of the urinary tract in nine. Pretreatment skin reactivity did not correlate with toxicity, and concurrent percutaneous administration of BCG had no effect on toxicity. BCG has a cumulative effect, so increased toxicity is to be expected during long-term administration. BCG toxicity is primarily a response of the cell-mediated immune system, and transient local or systemic infection appears to be important. This fact suggests that immunosuppression is a relative contraindication to BCG use.

Original languageEnglish (US)
Pages (from-to)326-333
Number of pages8
JournalCancer
Volume60
Issue number3
StatePublished - 1987
Externally publishedYes

Fingerprint

Mycobacterium bovis
Urinary Bladder Neoplasms
Urinary Bladder
Granuloma
Cutaneous Administration
Cystitis
Poisons
Contracture
Therapeutics
Urinary Tract
Immunosuppression
Human Influenza
Compliance
Immune System

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Orihuela, E., Herr, H. W., Pinsky, C. M., & Whitmore, W. F. (1987). Toxicity of intravesical BCG and its management in patients with superficial bladder tumors. Cancer, 60(3), 326-333.

Toxicity of intravesical BCG and its management in patients with superficial bladder tumors. / Orihuela, Eduardo; Herr, H. W.; Pinsky, C. M.; Whitmore, W. F.

In: Cancer, Vol. 60, No. 3, 1987, p. 326-333.

Research output: Contribution to journalArticle

Orihuela, E, Herr, HW, Pinsky, CM & Whitmore, WF 1987, 'Toxicity of intravesical BCG and its management in patients with superficial bladder tumors', Cancer, vol. 60, no. 3, pp. 326-333.
Orihuela E, Herr HW, Pinsky CM, Whitmore WF. Toxicity of intravesical BCG and its management in patients with superficial bladder tumors. Cancer. 1987;60(3):326-333.
Orihuela, Eduardo ; Herr, H. W. ; Pinsky, C. M. ; Whitmore, W. F. / Toxicity of intravesical BCG and its management in patients with superficial bladder tumors. In: Cancer. 1987 ; Vol. 60, No. 3. pp. 326-333.
@article{331756b2f531468cb9dc4cdc81c0044c,
title = "Toxicity of intravesical BCG and its management in patients with superficial bladder tumors",
abstract = "Toxicity of bacillus Calmette-Guerin (BCG) Pasteur strain, given in a dose of 120 mg once a week for 6 weeks, was retrospectively evaluated in a study of 107 patients with recurrent superficial bladder cancer. Only six patients had no symptoms of toxicity. Severe crystitis (ten patients) was most likely to occur in those with decreased bladder compliance before treatment. Systemic symptoms resembling those of influenza (flu) were severe in six patients. Potentially serious complications occurred in six patients. Overall, toxic reactions were mild and self limited, and toxicity often could be easily managed by a reduction in the BCG dose (17 patients), temporary interruption of treatment (five patients), or cessation (four patients). Late occurrence of bladder granulomas (32 patients) and cytoscopic appearance of significant cystitis (55 patients) did not correlate with posttreatment voiding symptoms, and these changes were temporary and confined to the first 6 months after treatment. There were no cases of late bladder contracture, and none of the patients free of voiding symptoms before treatment had such symptoms afterward. Extravesical granulomas were observed in 37 patients and were the cause of obstruction of the urinary tract in nine. Pretreatment skin reactivity did not correlate with toxicity, and concurrent percutaneous administration of BCG had no effect on toxicity. BCG has a cumulative effect, so increased toxicity is to be expected during long-term administration. BCG toxicity is primarily a response of the cell-mediated immune system, and transient local or systemic infection appears to be important. This fact suggests that immunosuppression is a relative contraindication to BCG use.",
author = "Eduardo Orihuela and Herr, {H. W.} and Pinsky, {C. M.} and Whitmore, {W. F.}",
year = "1987",
language = "English (US)",
volume = "60",
pages = "326--333",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "3",

}

TY - JOUR

T1 - Toxicity of intravesical BCG and its management in patients with superficial bladder tumors

AU - Orihuela, Eduardo

AU - Herr, H. W.

AU - Pinsky, C. M.

AU - Whitmore, W. F.

PY - 1987

Y1 - 1987

N2 - Toxicity of bacillus Calmette-Guerin (BCG) Pasteur strain, given in a dose of 120 mg once a week for 6 weeks, was retrospectively evaluated in a study of 107 patients with recurrent superficial bladder cancer. Only six patients had no symptoms of toxicity. Severe crystitis (ten patients) was most likely to occur in those with decreased bladder compliance before treatment. Systemic symptoms resembling those of influenza (flu) were severe in six patients. Potentially serious complications occurred in six patients. Overall, toxic reactions were mild and self limited, and toxicity often could be easily managed by a reduction in the BCG dose (17 patients), temporary interruption of treatment (five patients), or cessation (four patients). Late occurrence of bladder granulomas (32 patients) and cytoscopic appearance of significant cystitis (55 patients) did not correlate with posttreatment voiding symptoms, and these changes were temporary and confined to the first 6 months after treatment. There were no cases of late bladder contracture, and none of the patients free of voiding symptoms before treatment had such symptoms afterward. Extravesical granulomas were observed in 37 patients and were the cause of obstruction of the urinary tract in nine. Pretreatment skin reactivity did not correlate with toxicity, and concurrent percutaneous administration of BCG had no effect on toxicity. BCG has a cumulative effect, so increased toxicity is to be expected during long-term administration. BCG toxicity is primarily a response of the cell-mediated immune system, and transient local or systemic infection appears to be important. This fact suggests that immunosuppression is a relative contraindication to BCG use.

AB - Toxicity of bacillus Calmette-Guerin (BCG) Pasteur strain, given in a dose of 120 mg once a week for 6 weeks, was retrospectively evaluated in a study of 107 patients with recurrent superficial bladder cancer. Only six patients had no symptoms of toxicity. Severe crystitis (ten patients) was most likely to occur in those with decreased bladder compliance before treatment. Systemic symptoms resembling those of influenza (flu) were severe in six patients. Potentially serious complications occurred in six patients. Overall, toxic reactions were mild and self limited, and toxicity often could be easily managed by a reduction in the BCG dose (17 patients), temporary interruption of treatment (five patients), or cessation (four patients). Late occurrence of bladder granulomas (32 patients) and cytoscopic appearance of significant cystitis (55 patients) did not correlate with posttreatment voiding symptoms, and these changes were temporary and confined to the first 6 months after treatment. There were no cases of late bladder contracture, and none of the patients free of voiding symptoms before treatment had such symptoms afterward. Extravesical granulomas were observed in 37 patients and were the cause of obstruction of the urinary tract in nine. Pretreatment skin reactivity did not correlate with toxicity, and concurrent percutaneous administration of BCG had no effect on toxicity. BCG has a cumulative effect, so increased toxicity is to be expected during long-term administration. BCG toxicity is primarily a response of the cell-mediated immune system, and transient local or systemic infection appears to be important. This fact suggests that immunosuppression is a relative contraindication to BCG use.

UR - http://www.scopus.com/inward/record.url?scp=0023228973&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0023228973&partnerID=8YFLogxK

M3 - Article

VL - 60

SP - 326

EP - 333

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 3

ER -