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Chen CH, Kuo CC, Chiang BJ, Yu JY, Hsieh YT, Pu YS. The comparison of efficacy between the connaught and TICE strains of bacillus calmette-guerin in patients with non-muscle-invasive bladder cancer in Taiwan. UROLOGICAL SCIENCE 2022. [DOI: 10.4103/uros.uros_141_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tham SM, Rahmat JN, Chiong E, Wu Q, Esuvaranathan K, Mahendran R. Intravesical High Dose BCG Tokyo and Low Dose BCG Tokyo with GMCSF+IFN α Induce Systemic Immunity in a Murine Orthotopic Bladder Cancer Model. Biomedicines 2021; 9:biomedicines9121766. [PMID: 34944584 PMCID: PMC8698822 DOI: 10.3390/biomedicines9121766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 11/21/2022] Open
Abstract
This study evaluates a short therapy schedule for bladder cancer using BCG Tokyo. BCG Tokyo was evaluated in vitro using bone marrow derived dendritic cells, neutrophils, RAW macrophages and the murine bladder cancer cell line, MB49PSA, and compared to other BCG strains. BCG Tokyo > BCG TICE at inducing cytokine production. In vivo, high dose (1 × 107 colony forming units (cfu)) and low dose (1 × 106 cfu) BCG Tokyo with and without cytokine genes (GMCSF + IFNα) were evaluated in C57BL/6J mice (n = 12–16 per group) with orthotopically implanted MB49PSA cells. Mice were treated with four instillations of cytokine gene therapy and BCG therapy. Both high dose BCG alone and low dose BCG combined with cytokine gene therapy were similarly effective. In the second part the responsive groups, mice (n = 27) were monitored by urinary PSA analysis for a further 7 weeks after therapy cessation. More mice were cured at day 84 than at day 42 confirming activation of the immune system. Cured mice resisted the re-challenge with subcutaneous tumors unlike naïve, age matched mice. Antigen specific T cells recognizing BCG, HY and PSA were identified. Thus, fewer intravesical instillations, with high dose BCG Tokyo or low dose BCG Tokyo with GMCSF + IFNα gene therapy, can induce effective systemic immunity.
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Affiliation(s)
- Sin Mun Tham
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 8, 1E Kent Ridge Road, Singapore 119228, Singapore; (S.M.T.); (J.N.R.); (E.C.); (K.E.)
| | - Juwita N. Rahmat
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 8, 1E Kent Ridge Road, Singapore 119228, Singapore; (S.M.T.); (J.N.R.); (E.C.); (K.E.)
- Department of Bioengineering, National University of Singapore, Singapore 119077, Singapore
| | - Edmund Chiong
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 8, 1E Kent Ridge Road, Singapore 119228, Singapore; (S.M.T.); (J.N.R.); (E.C.); (K.E.)
- Department of Urology, National University Hospital, National University Health System, Singapore 119228, Singapore;
| | - Qinghui Wu
- Department of Urology, National University Hospital, National University Health System, Singapore 119228, Singapore;
| | - Kesavan Esuvaranathan
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 8, 1E Kent Ridge Road, Singapore 119228, Singapore; (S.M.T.); (J.N.R.); (E.C.); (K.E.)
- Department of Urology, National University Hospital, National University Health System, Singapore 119228, Singapore;
| | - Ratha Mahendran
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 8, 1E Kent Ridge Road, Singapore 119228, Singapore; (S.M.T.); (J.N.R.); (E.C.); (K.E.)
- Correspondence: ; Tel.: +65-6601-3982; Fax: +65-6777-8427
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Koti M, Chenard S, Nersesian S, Vidotto T, Morales A, Siemens DR. Investigating the STING Pathway to Explain Mechanisms of BCG Failures in Non-Muscle Invasive Bladder Cancer: Prognostic and Therapeutic Implications. Bladder Cancer 2019. [DOI: 10.3233/blc-190228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Madhuri Koti
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Canada
- Department of Obstetrics and Gynecology, Kingston Health Sciences Center, Queen’s University, Kingston, Canada
- Cancer Biology and Genetics, Queen’s Cancer Research Institute, Queen’s University, Kingston, Canada
- Department of Urology, Kingston Health Sciences Center, Queen’s University, Kingston, Canada
| | - Stephen Chenard
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Canada
- Cancer Biology and Genetics, Queen’s Cancer Research Institute, Queen’s University, Kingston, Canada
- Department of Urology, Kingston Health Sciences Center, Queen’s University, Kingston, Canada
| | | | - Thiago Vidotto
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alvaro Morales
- Department of Urology, Kingston Health Sciences Center, Queen’s University, Kingston, Canada
| | - D. Robert Siemens
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Canada
- Cancer Biology and Genetics, Queen’s Cancer Research Institute, Queen’s University, Kingston, Canada
- Department of Urology, Kingston Health Sciences Center, Queen’s University, Kingston, Canada
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Abstract
BCG immunotherapy is the gold-standard treatment for non-muscle-invasive bladder cancer at high risk of recurrence or progression. Preclinical and clinical studies have revealed that a robust inflammatory response to BCG involves several steps: attachment of BCG; internalization of BCG into resident immune cells, normal cells, and tumour urothelial cells; BCG-mediated induction of innate immunity, which is orchestrated by a cellular and cytokine milieu; and BCG-mediated initiation of tumour-specific immunity. As an added layer of complexity, variation between clinical BCG strains might influence development of tumour immunity. However, more than 40 years after the first use of BCG for bladder cancer, many questions regarding its mechanism of action remain unanswered. Clearly, a better understanding of the mechanisms underlying BCG-mediated tumour immunity could lead to improved efficacy, increased tolerance of treatment, and identification of novel immune-based therapies. Indeed, enthusiasm for bladder cancer immunotherapy, and the possibility of combining BCG with other therapies, is increasing owing to the availability of targeted immunotherapies, including checkpoint inhibitors. Understanding of the mechanism of action of BCG immunotherapy has advanced greatly, but many questions remain, and further basic and clinical research efforts are needed to develop new treatment strategies for patients with bladder cancer.
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Tan GH, Kuk C, Zlotta AR. Are there differences among bacillus Calmette-Guérin (BCG) strains regarding their clinical efficacy in the treatment of non-muscleinvasive bladder cancer? The jury is still out but the answer is likely no. Can Urol Assoc J 2019; 14:E54-E56. [PMID: 31348742 DOI: 10.5489/cuaj.5923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Guan Hee Tan
- Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, ON, Canada
| | - Cynthia Kuk
- Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, ON, Canada.,Division of Urology, Department of Surgery, Sinai Health System, Toronto, ON, Canada
| | - Alexandre R Zlotta
- Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, ON, Canada.,Division of Urology, Department of Surgery, Sinai Health System, Toronto, ON, Canada
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Building on a Solid Foundation: Enhancing Bacillus Calmette-Guérin Therapy. Eur Urol Focus 2018; 4:485-493. [DOI: 10.1016/j.euf.2018.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/13/2018] [Accepted: 10/19/2018] [Indexed: 01/08/2023]
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Steinberg RL, Brooks NA, Thomas LJ, Mott SL, O’Donnell MA. Bacillus Calmette-Guerin strain may not effect recurrence-free survival when used intravesically with interferon-alpha2b for non–muscle-invasive bladder cancer. Urol Oncol 2017; 35:201-207. [DOI: 10.1016/j.urolonc.2016.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/02/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022]
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Optimal Dose and Duration of bacillus Calmette-Guérin Therapy for Urothelial Carcinoma of the Bladder. J Urol 2016; 195:9-10. [DOI: 10.1016/j.juro.2015.10.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2015] [Indexed: 11/24/2022]
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Abstract
Introduction: Nonmuscle invasive urothelial cell carcinoma is the most frequent malignancy of the urinary bladder. The high recurrence rate (up to 80%) and risk of progression (up to 30%) reflect the need for long-term follow-up and sometimes multiple interventions. To reduce the rate of recurrences and tumor progression, intravesical immunotherapy, especially the use of Bacille Calmette-Guerin (BCG), represents the gold standard adjuvant treatment of high-risk nonmuscle invasive bladder cancer (NMIBC). This article reviews the role of BCG therapy and several promising new immunotherapeutic approaches such as mycobacterium phlei cell wall-nucleic acid complex, interleukin-10 (IL-10) antibody, vaccine-based therapy, alpha-emitter therapy, and photodynamic therapy checkpoint inhibitors. Methods: A systematic literature review was performed using the terms (immunotherapy, NMIBC, BCG, and intravesical) using PubMed and Cochrane databases. Results: BCG represents the most common intravesical immunotherapeutic agent for the adjuvant treatment of high-risk NMIBC. Its use is associated with a significant reduction of recurrence and progression. Patients with NMIBC of intermediate and high-risk benefit the most from BCG therapy. To achieve maximal efficacy, an induction therapy followed by a maintenance schedule should be used. Full-dose BCG is recommended to obtain ideal antitumoral activity and there is no evidence of a reduction of side effects in patients treated with a reduced dose. There are multiple new approaches and agents in immunotherapy with potential and promising antineoplastic effects. Conclusions: The beneficial effect of BCG is well documented and established. To reduce the tumor specific mortality, it is essential to follow guideline-based treatment. In patients with BCG-failure, there are new promising alternatives other than BCG but BCG remains the gold standard at this stage.
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Hofbauer SL, Shariat SF, Chade DC, Sarkis AS, Ribeiro-Filho LA, Nahas WC, Klatte T. The Moreau Strain of Bacillus Calmette-Guerin (BCG) for High-Risk Non-Muscle Invasive Bladder Cancer: An Alternative during Worldwide BCG Shortage? Urol Int 2015; 96:46-50. [PMID: 26555711 DOI: 10.1159/000440701] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 08/26/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bacillus Calmette-Guerin (BCG) is the standard of care for adjuvant intravesical instillation therapy for intermediate- and high-risk non-muscle invasive bladder cancer (NMIBC) after complete transurethral resection. Increasing evidence suggests that there are marked differences in outcomes according to BCG substrains. BCG-Moreau was recently introduced to the European market to cover the issue of BCG shortage, but there are little data regarding the oncologic efficacy. METHODS We retrospectively analyzed 295 consecutive patients, who received adjuvant intravesical instillation therapy with BCG-Moreau for intermediate- and high-risk NMIBC between October 2007 and April 2013 at a single institution. The end points of this study were time to first recurrence and progression to muscle-invasive disease. RESULTS Median age was 66 years (interquartile range 59-74, mean 65.9 years). According to the EAU risk group, 76 patients presented with intermediate-risk and 219 patients with high-risk NMIBC. The 5-year recurrence-free survival and progression-free survival rate was 64.8% (95% CI 52.8-74.4) and 81.4% (95% CI 65.2-90.2), respectively. CONCLUSIONS BCG-Moreau is an effective substrain for adjuvant instillation therapies of NMIBC, and outcomes appear to be comparable to series using other substrains. During worldwide shortage of BCG-TICE, Connaught and RIVM, BCG-Moreau may serve as an equally effective alternative.
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Affiliation(s)
- Sebastian L Hofbauer
- Department of Urology, Medical University of Vienna and General Hospital, Vienna, Austria
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