1
|
Breyer J, Burger M, Otto W. Immunotherapy in urothelial carcinoma: fade or future standard? Transl Androl Urol 2016; 5:662-667. [PMID: 27785423 PMCID: PMC5071200 DOI: 10.21037/tau.2016.04.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Immunotherapy of non-muscle-invasive bladder carcinoma by Bacillus-Calmette-Guérin (BCG) instillation is a well-established treatment option since decades. Despite this fact, the immunocellular basis was first studied in recent years. New aspects of immunotherapy, also for progressed bladder carcinoma, might follow promising research on immunological targets.
Collapse
Affiliation(s)
- Johannes Breyer
- Department of Urology, Medical Center St. Josef, Regensburg University Medical Center, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, Medical Center St. Josef, Regensburg University Medical Center, Regensburg, Germany
| | - Wolfgang Otto
- Department of Urology, Medical Center St. Josef, Regensburg University Medical Center, Regensburg, Germany; ; Urologische Praxis Dr. Raab, Abensberg, Germany
| |
Collapse
|
2
|
Abstract
It is nearly 40 years since Bacillus Calmette-Guérin (BCG) was first used as an immunotherapy to treat superficial bladder cancer. Despite its limitations, to date it has not been surpassed by any other treatment. As a better understanding of its mechanism of action and the clinical response to it have evolved, some of the questions around optimal dosing and treatment protocols have been answered. However, its potential for toxicity and failure to produce the desired clinical effect in a significant cohort of patients presents an ongoing challenge to clinicians and researchers alike. This review summarizes the evidence behind the established mechanism of action of BCG in bladder cancer, highlighting the extensive array of immune molecules that have been implicated in its action. The clinical aspects of BCG are discussed, including its role in reducing recurrence and progression, the optimal treatment regime, toxicity and, in light of new evidence, whether or not there is a superior BCG strain. The problems of toxicity and non-responders to BCG have led to development of new techniques aimed at addressing these pitfalls. The progress made in the laboratory has led to the identification of novel targets for the development of new immunotherapies. This includes the potential augmentation of BCG with various immune factors through to techniques avoiding the use of BCG altogether; for example, using interferon-activated mononuclear cells, BCG cell wall, or BCG cell wall skeleton. The potential role of gene, virus, or photodynamic therapy as an alternative to BCG is also reviewed. Recent interest in the immune check point system has led to the development of monoclonal antibodies against proteins involved in this pathway. Early findings suggest benefit in metastatic disease, although the role in superficial bladder cancer remains unclear.
Collapse
Affiliation(s)
- Oliver Fuge
- Department of Urology, Lister Hospital, Stevenage, UK
| | - Nikhil Vasdev
- Department of Urology, Lister Hospital, Stevenage, UK
| | - Paula Allchorne
- Department of Urology, Bartshealth NHS Trust, Whipps Cross Rd, London, UK
| | - James Sa Green
- Department of Urology, Bartshealth NHS Trust, Whipps Cross Rd, London, UK
| |
Collapse
|
3
|
Niegisch G, Hulsbergen-van de Kaa C, Ploeg M, Hendricksen K, Witjes JA. Do Orthotopic Ileal Diversions Induce Immunological Changes in Retained Urethral Tissue? Bladder Cancer 2015; 1:97-103. [PMID: 30561440 PMCID: PMC6218181 DOI: 10.3233/blc-140001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background A second primary tumors of the urethra (urethral recurrence) after radical cystectomy has been reported to be more infrequent in patients with ileal orthotopic (neobladder) compared to incontinent diversions. Objective To investigate whether an altered immunogenic environment of urethral tissue is induced by urethro-ileal anastomosis. Methods Between 10/2008 and 12/2009 urethral biopsies of 19 patients (9 neobladder patients, 10 control patients without urethra-ileal anastomosis) were evaluated by conventional histopathological examination and immunohistochemistry for T- (CD3/CD5, CD4, CD8) and B-cell markers (CD20/22, CD79a, CD138). After semi-quantitative assessment, relative cell fractions (B vs. T cells) and subclasses (T4-helper vs. T8-killer cells vs. B cell clones, plasma cells) in neobladder vs. control patients were studied. Unpaired t-test was used for statistical analysis. Results Of 19 included patients, 16 were eligible for analysis (7x neobladder, 9x controls). All neobladder patients had undergone cystectomy for UBC. Comparing relative fractions of cells positive for T- and B-cell markers in NB and CO patients, no statistical differences were observed. In 4/7 neobladder patients relative fraction of CD79a positive B-cells was higher than relative fraction of CD3/CD5 positive T-cells (B/T-ratio 1.3). B cells were predominantly CD138 positive plasma cells (5/7 NB patients). Relative B-cell fraction was lower than T-cell fraction in 7/9 control patients (B/T-ratio 0.6). Neither CD 138 positive plasma cells nor CD22 positive B cell clones were predominant. T-helper and CD8 positive T-killer cells were equally distributed in both neobladder (CD4/CD8-ratio: 2.1) and control patients (CD4/CD8-ratio: 1.9). Conclusions Comparing neobadder and control patients the distribution of B- and T-cells was statistically not different. However, a trend towards an increased presence of B-cells in urethral tissues of NB patients that could become relevant in a larger study might be suggestive for an immunological response induced by connecting urethral and ileal tissue.
Collapse
Affiliation(s)
- Günter Niegisch
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Urology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Martine Ploeg
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kees Hendricksen
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
4
|
Ping SY, Wu CL, Yu DS. Sunitinib can enhance BCG mediated cytotoxicity to transitional cell carcinoma through apoptosis pathway. Urol Oncol 2012; 30:652-9. [DOI: 10.1016/j.urolonc.2010.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 07/05/2010] [Accepted: 07/06/2010] [Indexed: 10/19/2022]
|
5
|
|
6
|
Discriminators of mouse bladder response to intravesical Bacillus Calmette-Guerin (BCG). BMC Immunol 2007; 8:6. [PMID: 17506885 PMCID: PMC1891101 DOI: 10.1186/1471-2172-8-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2007] [Accepted: 05/16/2007] [Indexed: 11/10/2022] Open
Abstract
Background Intravesical Bacillus Calmette-Guerin (BCG) is an effective treatment for bladder superficial carcinoma and it is being tested in interstitial cystitis patients, but its precise mechanism of action remains poorly understood. It is not clear whether BCG induces the release of a unique set of cytokines apart from its pro-inflammatory effects. Therefore, we quantified bladder inflammatory responses and alterations in urinary cytokine protein induced by intravesical BCG and compared the results to non-specific pro-inflammatory stimuli (LPS and TNF-α). We went further to determine whether BCG treatment alters cytokine gene expression in the urinary bladder. Methods C57BL/6 female mice received four weekly instillations of BCG, LPS, or TNF-α. Morphometric analyses were conducted in bladders isolated from all groups and urine was collected for multiplex analysis of 18 cytokines. In addition, chromatin immune precipitation combined with real-time polymerase chain reaction assay (CHIP/Q-PCR) was used to test whether intravesical BCG would alter bladder cytokine gene expression. Results Acute BCG instillation induced edema which was progressively replaced by an inflammatory infiltrate, composed primarily of neutrophils, in response to weekly administrations. Our morphological analysis suggests that these polymorphonuclear neutrophils are of prime importance for the bladder responses to BCG. Overall, the inflammation induced by BCG was higher than LPS or TNF-α treatment but the major difference observed was the unique granuloma formation in response to BCG. Among the cytokines measured, this study highlighted the importance of IL-1β, IL-2, IL-3, IL-4, IL-6, IL-10, IL-17, GM-CSF, KC, and Rantes as discriminators between generalized inflammation and BCG-specific inflammatory responses. CHIP/Q-PCR indicates that acute BCG instillation induced an up-regulation of IL-17A, IL-17B, and IL-17RA, whereas chronic BCG induced IL-17B, IL-17RA, and IL-17RB. Conclusion To the best of our knowledge, the present work is the first to report that BCG induces an increase in the IL-17 family genes. In addition, BCG induces a unique type of persisting bladder inflammation different from TNF-α, LPS, and, most likely, other classical pro-inflammatory stimuli.
Collapse
|
7
|
Park KK, Bang WJ, Seo JW, Kim YS, Lee SY, Ko WJ. The Effect of Oral Prednisolone on Pseudo-tumor following Bacillus Calmette Guerin Intravesical Instillation. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.4.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Kyung Kgi Park
- Department of Urology, National Health Insurance Corporation Ilsan Hospital, Yonsei University College of Medicine, Goyang, Korea
| | - Woo Jin Bang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Wan Seo
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sig Kim
- Department of Urology, National Health Insurance Corporation Ilsan Hospital, Yonsei University College of Medicine, Goyang, Korea
| | - Suk Young Lee
- Department of Urology, National Health Insurance Corporation Ilsan Hospital, Yonsei University College of Medicine, Goyang, Korea
| | - Woo Jin Ko
- Department of Urology, National Health Insurance Corporation Ilsan Hospital, Yonsei University College of Medicine, Goyang, Korea
| |
Collapse
|
8
|
Perabo FGE, Willert PL, Wirger A, Schmidt DH, Wardelmann E, Sitzia M, von Ruecker A, Mueller SC. Preclinical evaluation of superantigen (staphylococcal enterotoxin B) in the intravesical immunotherapy of superficial bladder cancer. Int J Cancer 2005; 115:591-8. [PMID: 15704106 DOI: 10.1002/ijc.20941] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Superantigens are potent activators of T lymphocytes; therefore, their characteristics can be exploited in diseases where immunomodulation is known to be effective. In this study, we evaluated a new approach for the intravesical therapy of superficial bladder cancer. We investigated in coculture experiments if staphylococcal enterotoxin B (SEB)-activated PBMCs are able to induce apoptosis in human transitional cell carcinoma (TCC) cells. Additionally, we tested the toxicity and efficacy of SEB dissolved in NaCl 0.9% administered intravesically once weekly for 6 weeks in a rat bladder cancer model. To validate the coculture in vitro findings, we evaluated tumor stage, grade, apoptotic cells in the urothelium and stroma of the bladder and infiltration of the bladder wall by lymphocytes, macrophages and mononuclear cells. Coculture experiments revealed that SEB-activated PBMCs are able to kill TCC cells by inducing apoptosis. The intravesical toxicity study with a maximum dose of 100 microg/ml SEB demonstrated no side effects. In the intravesically SEB-treated animals (10 microg/ml), only 3 tumors remained vs. 15 persisting tumors in the control group. The remaining tumors of the therapy group showed a significant amount of apoptosis and granulocytes, mainly in the urothelium, whereas no relevant apoptosis or infiltration of the bladder with lymphocytes or macrophages was found in the control group. These preclinical findings suggest that SEB might be an interesting candidate for further clinical evaluation.
Collapse
|
9
|
Bergami-Santos PC, Mariano M, Barbuto JAM. Dual role of polymorphonuclear neutrophils on the growth of Ehrlich ascites tumor (EAT) in mice. Life Sci 2004; 75:245-55. [PMID: 15120576 DOI: 10.1016/j.lfs.2004.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2004] [Accepted: 02/22/2004] [Indexed: 10/26/2022]
Abstract
We show that granulocytes (PMN) have a dual role in the development of Ehrlich Ascites Tumor (EAT) in mice. EAT intraperitoneal inoculation causes a local inflammatory reaction, ascites development and mortality that distinguish resistant and susceptible strains. In resistant mice (CAF1), there is a less pronounced PMN influx after EAT inoculation than in susceptible Swiss mice. Accordingly, the increase in peritoneal PMN numbers enhanced tumor growth in CAF1 mice, but had no effect in the susceptible Swiss animals. Contrastingly, PMN depletion had no effect in resistant mice but facilitated tumor growth in susceptible animals. Though no differences were noted between the strains in peritoneal cell spreading and hydrogen peroxide release after tumor inoculation, in vitro PMN cytotoxic activity against EAT was significantly higher in susceptible Swiss mice. These data indicate a paradoxical dual role for PMN against EAT: while they help control tumor development in susceptible animals, they seem to enhance tumor growth in resistant mice.
Collapse
Affiliation(s)
- Patrícia C Bergami-Santos
- Departamento de Imunologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, Av. Professor Lineu Prestes, 1730, Cidade Universitária, CEP 05508-000, São Paulo, Brazil
| | | | | |
Collapse
|
10
|
Atkins H, Davies BR, Kirby JA, Kelly JD. Polarisation of a T-helper cell immune response by activation of dendritic cells with CpG-containing oligonucleotides: a potential therapeutic regime for bladder cancer immunotherapy. Br J Cancer 2004; 89:2312-9. [PMID: 14676812 PMCID: PMC2395264 DOI: 10.1038/sj.bjc.6601474] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Intravesical bacillus Calmette–Guerin (BCG) is a treatment for transitional cell carcinoma (TCC) and carcinoma in situ (cis) of the urinary bladder, but some patients remain refractory. The mechanism of cancer clearance is not known, but T cells are thought to play a contributory role. Tissue dendritic cells (DCs) are known to initiate antigen-specific immune responses following activation of receptors, which recognise molecular patterns on the surface of microorganisms. A family of these receptors, the toll-like receptors (TLRs), are also crucial for activating DC to produce cytokines that polarise the T-cell response towards a T helper (Th)1 or Th2 phenotype. This study compared the potential of intact BCG to activate DC with that of the defined TLR4 ligand lipopolysaccharide (LPS) and the TLR9 ligand CpG-oligonucleotide. It was found that all three stimuli efficiently activated normal DC, but cells expressing a mutant TLR4 responded poorly to stimulation with LPS. Importantly, stimulation with BCG induced both IL-12 and IL-10, suggesting subsequent development of a poorly focused T-cell immune response containing both Th1 and Th2 immune function. By contrast, LPS- and CpG-oligonucleotides induced only IL-12, indicating the potential to produce a Th1 response, which is likely to clear cancer most efficiently. Given the toxicity of LPS, our data suggest that CpG-oligonucleotides may be beneficial for intravesical therapy of bladder cancer.
Collapse
Affiliation(s)
- H Atkins
- Northern Institute for Cancer Research, School of Surgical and Reproductive Sciences, Faculty of Medical Sciences, University of Newcastle, Framlington Place, Newcastle-Upon-Tyne NE2 4HH, UK
| | - B R Davies
- Northern Institute for Cancer Research, School of Surgical and Reproductive Sciences, Faculty of Medical Sciences, University of Newcastle, Framlington Place, Newcastle-Upon-Tyne NE2 4HH, UK
| | - J A Kirby
- Northern Institute for Cancer Research, School of Surgical and Reproductive Sciences, Faculty of Medical Sciences, University of Newcastle, Framlington Place, Newcastle-Upon-Tyne NE2 4HH, UK
- Northern Institute for Cancer Research, School of Surgical and Reproductive Sciences, Faculty of Medical Sciences, University of Newcastle, Framlington Place, Newcastle-Upon-Tyne NE2 4HH, UK. E-mail:
| | - J D Kelly
- Northern Institute for Cancer Research, School of Surgical and Reproductive Sciences, Faculty of Medical Sciences, University of Newcastle, Framlington Place, Newcastle-Upon-Tyne NE2 4HH, UK
| |
Collapse
|
11
|
Adoptive Immunotherapy For Superficial Bladder Cancer With Autologous Macrophage Activated Killer Cells. J Urol 2002. [DOI: 10.1097/00005392-200212000-00006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Thiounn N, Pages F, Mejean A, Descotes JL, Fridman WH, Romet-Lemonne JL. Adoptive immunotherapy for superficial bladder cancer with autologous macrophage activated killer cells. J Urol 2002; 168:2373-6. [PMID: 12441920 DOI: 10.1016/s0022-5347(05)64148-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We assessed the efficacy and safety of adoptive immunotherapy administered to 17 patients with TaGIII or recurrent TaGII superficial bladder cancer following transurethral tumor resection. MATERIALS AND METHODS Macrophage activated killer (MAK) cells were obtained from autologous mononuclear cells harvested by apheresis, after in vitro culture for 7 days and activation with interferon-gamma on the last day of culture. The patients received 6 weekly intravesical infusions of approximately 2 x 10(8) cells each. Additionally, 5 patients received 2 or 3 more infusions at 3-month intervals. Each patient was followed for 1 year or until tumor recurrence, whichever came first. RESULTS A total of 112 intravesical infusions were performed. During the 12-month followup period 8 patients experienced 11 common toxicity criteria grade 1 or grade 2 adverse events considered possibly related to protocol. No clinically relevant grade 1 or 2 laboratory test results were reported while the patients received treatment. In 17 patients 8 tumors recurred compared to 34 recurrences during the year before the first MAK cell infusion. This difference was highly significant (p </=0.0005). CONCLUSIONS The promising efficacy and safety results of this study and the fact that the MAK cell treatment regimen proved feasible should encourage initiation of further large scale studies to confirm these data.
Collapse
|
13
|
Saint F, Patard JJ, Groux Muscatelli B, Lefrere Belda MA, Gil Diez de Medina S, Abbou CC, Chopin DK. Evaluation of cellular tumour rejection mechanisms in the peritumoral bladder wall after bacillus Calmette-Guérin treatment. BJU Int 2001; 88:602-10. [PMID: 11678759 DOI: 10.1046/j.1464-410x.2001.02394.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the immunological status of normal and peritumoral bladder walls, and to characterize immunocompetent cells before and during intravesical instillations of bacillus Calmette-Guérin (BCG). PATIENTS AND METHODS Twenty-three patients with superficial urothelial bladder carcinoma (stages pTa to pT1, grades 1-3) were treated with six weekly instillations of 150 mg of BCG (Pasteur strain). Biopsies of cystoscopically normal bladder wall were taken before, 3 weeks and 3 months after BCG instillation. The controls comprised bladder biopsy specimens from 13 brain-dead ventilated kidney donors. Local infiltrating cell types, i.e. lymphocyte infiltrates (CD4, CD8, CD20, CD3, interleukin-2-receptor-positive, natural killer, gammadelta), macrophages and dendritic cells, adhesion and costimulatory molecules (ICAM-1 and B7-BB1) and major histocompatibility complex (MHC) class I and class II antigens were assessed using semi-quantitative immunohistochemical analysis. RESULTS Before BCG the peritumoral bladder wall had fewer macrophages than control bladder wall. BCG treatment restored normal numbers of macrophages and enhanced T helper lymphocytes, B lymphocytes, natural killer cells, activated lymphocytes, dendritic cells, normal MHC class I, adhesion (ICAM-1) and costimulatory (B7-BB1) expression. The enhancement of these immunological variables was transient, with a return to baseline 3 months after BCG instillation. CONCLUSIONS These results support the concept that there is a host-immune escape associated with bladder cancer. BCG therapy may temporarily restore impaired tumour rejection mechanisms in the peritumoral bladder wall, suggesting a need for maintenance therapy after the first course of BCG.
Collapse
Affiliation(s)
- F Saint
- Department of Urology, Hôpital Henri Mondor, Créteil, France
| | | | | | | | | | | | | |
Collapse
|
14
|
PAVLOVICH CHRISTIANP, KRÄLING BIRGITM, STEWART ROBERTJ, CHEN XIAOHONG, BOCHNER BERNARDH, LUSTER ANDREWD, POPPAS DIXP, O’DONNELL MICHAELA. BCG-INDUCED URINARY CYTOKINES INHIBIT MICROVASCULAR ENDOTHELIAL CELL PROLIFERATION. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67620-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- CHRISTIAN P. PAVLOVICH
- From the James Buchanan Brady Foundation, Department of Urology, The New York Hospital - Cornell Medical Center, New York, New York, the Surgical Research Laboratory, Department of Surgery, Children’s Hospital - Harvard Medical School, Boston, Massachusetts, the Division of Urology, Department of Surgery, The Toronto Hospital, University of Toronto, Toronto, Canada, the Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center - Harvard Medical School, Boston, Massachusetts,
| | - BIRGIT M. KRÄLING
- From the James Buchanan Brady Foundation, Department of Urology, The New York Hospital - Cornell Medical Center, New York, New York, the Surgical Research Laboratory, Department of Surgery, Children’s Hospital - Harvard Medical School, Boston, Massachusetts, the Division of Urology, Department of Surgery, The Toronto Hospital, University of Toronto, Toronto, Canada, the Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center - Harvard Medical School, Boston, Massachusetts,
| | - ROBERT J. STEWART
- From the James Buchanan Brady Foundation, Department of Urology, The New York Hospital - Cornell Medical Center, New York, New York, the Surgical Research Laboratory, Department of Surgery, Children’s Hospital - Harvard Medical School, Boston, Massachusetts, the Division of Urology, Department of Surgery, The Toronto Hospital, University of Toronto, Toronto, Canada, the Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center - Harvard Medical School, Boston, Massachusetts,
| | - XIAOHONG CHEN
- From the James Buchanan Brady Foundation, Department of Urology, The New York Hospital - Cornell Medical Center, New York, New York, the Surgical Research Laboratory, Department of Surgery, Children’s Hospital - Harvard Medical School, Boston, Massachusetts, the Division of Urology, Department of Surgery, The Toronto Hospital, University of Toronto, Toronto, Canada, the Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center - Harvard Medical School, Boston, Massachusetts,
| | - BERNARD H. BOCHNER
- From the James Buchanan Brady Foundation, Department of Urology, The New York Hospital - Cornell Medical Center, New York, New York, the Surgical Research Laboratory, Department of Surgery, Children’s Hospital - Harvard Medical School, Boston, Massachusetts, the Division of Urology, Department of Surgery, The Toronto Hospital, University of Toronto, Toronto, Canada, the Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center - Harvard Medical School, Boston, Massachusetts,
| | - ANDREW D. LUSTER
- From the James Buchanan Brady Foundation, Department of Urology, The New York Hospital - Cornell Medical Center, New York, New York, the Surgical Research Laboratory, Department of Surgery, Children’s Hospital - Harvard Medical School, Boston, Massachusetts, the Division of Urology, Department of Surgery, The Toronto Hospital, University of Toronto, Toronto, Canada, the Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center - Harvard Medical School, Boston, Massachusetts,
| | - DIX P. POPPAS
- From the James Buchanan Brady Foundation, Department of Urology, The New York Hospital - Cornell Medical Center, New York, New York, the Surgical Research Laboratory, Department of Surgery, Children’s Hospital - Harvard Medical School, Boston, Massachusetts, the Division of Urology, Department of Surgery, The Toronto Hospital, University of Toronto, Toronto, Canada, the Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center - Harvard Medical School, Boston, Massachusetts,
| | - MICHAEL A. O’DONNELL
- From the James Buchanan Brady Foundation, Department of Urology, The New York Hospital - Cornell Medical Center, New York, New York, the Surgical Research Laboratory, Department of Surgery, Children’s Hospital - Harvard Medical School, Boston, Massachusetts, the Division of Urology, Department of Surgery, The Toronto Hospital, University of Toronto, Toronto, Canada, the Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center - Harvard Medical School, Boston, Massachusetts,
| |
Collapse
|
15
|
BCG-INDUCED URINARY CYTOKINES INHIBIT MICROVASCULAR ENDOTHELIAL CELL PROLIFERATION. J Urol 2000. [DOI: 10.1097/00005392-200006000-00112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
ZHANG GUANGJIAN, CRIST SCOTTA, MCKERROW AMYK, XU YONG, LADEHOFF DAVIDC, SEE WILLIAMA. AUTOCRINE IL-6 PRODUCTION BY HUMAN TRANSITIONAL CARCINOMA CELLS UPREGULATES EXPRESSION OF THE α5β1 FIBRONECTIN RECEPTOR. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67678-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- GUANG-JIAN ZHANG
- From the University of Iowa Department of Urology, Iowa City, Iowa, and the Medical College of Wisconsin Division of Urology, Milwaukee, Wisconsin
| | - SCOTT A. CRIST
- From the University of Iowa Department of Urology, Iowa City, Iowa, and the Medical College of Wisconsin Division of Urology, Milwaukee, Wisconsin
| | - AMY K. MCKERROW
- From the University of Iowa Department of Urology, Iowa City, Iowa, and the Medical College of Wisconsin Division of Urology, Milwaukee, Wisconsin
| | - YONG XU
- From the University of Iowa Department of Urology, Iowa City, Iowa, and the Medical College of Wisconsin Division of Urology, Milwaukee, Wisconsin
| | - DAVID C. LADEHOFF
- From the University of Iowa Department of Urology, Iowa City, Iowa, and the Medical College of Wisconsin Division of Urology, Milwaukee, Wisconsin
| | - WILLIAM A. SEE
- From the University of Iowa Department of Urology, Iowa City, Iowa, and the Medical College of Wisconsin Division of Urology, Milwaukee, Wisconsin
| |
Collapse
|
17
|
Naitoh J, Franklin J, O'Donnell MA, Belldegrun AS. Interferon alpha for the treatment of superficial bladder cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2000; 462:371-86; discussion 387-92. [PMID: 10599440 DOI: 10.1007/978-1-4615-4737-2_29] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- J Naitoh
- UCLA Medical Center 90024-1782, USA
| | | | | | | |
Collapse
|
18
|
SYSTEMIC AND LOCAL IMMUNOMODULATORY EFFECTS OF INTRAVESICAL BCG THERAPY IN PATIENTS WITH SUPERFICIAL URINARY BLADDER CARCINOMAS. J Urol 2000. [DOI: 10.1097/00005392-200001000-00084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
19
|
SYSTEMIC AND LOCAL IMMUNOMODULATORY EFFECTS OF INTRAVESICAL BCG THERAPY IN PATIENTS WITH SUPERFICIAL URINARY BLADDER CARCINOMAS. J Urol 2000. [DOI: 10.1016/s0022-5347(05)68041-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
20
|
Intravesical bacille calmette-guérin induces the antiangiogenic chemokine interferon-inducible protein 10. Urology 1998. [DOI: 10.1016/s0090-4295(98)00188-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
21
|
Mungan NA, Witjes JA. Bacille Calmette-Guérin in superficial transitional cell carcinoma. BRITISH JOURNAL OF UROLOGY 1998; 82:213-23. [PMID: 9722756 DOI: 10.1046/j.1464-410x.1998.00720.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The mechanisms by which BCG exerts its antitumour activity remain unclear. Attachment of BCG to the bladder via FN has been shown to be an important step in initiating its antitumorigenic activity. The mechanism(s) by which BCG operates requires LAK cells, BCG-activated killer cells, T lymphocytes (CD4) helper cells and CD8 suppressor/cytotoxic cells) and monocytes. The optimal route of administration is intravesical. The efficacy of a BCG vaccine depends on the viability, dose and strain. Differences in efficacy and side-effects have not been shown between different strains. Low-dose regimens successfully protect from recurrences, with fewer side-effects. The initial schedule of BCG is a course of six instillations in 6 weeks; when the patient fails this course, two possibilities arise. The first is maintenance therapy; response rates improve but there is more local and systemic toxicity. The second is a further 6-week course, and this seems most useful in those with a sustained response to the initial treatment. The clinical response to BCG therapy can be monitored using cytokine measurements or p53 determinations. Toxicity remains a major problem in BCG treatment and triple antituberculosis combination therapy should be given for 3 months in those with severe systemic side-effects. The use of prophylactic isoniazid is not recommend to decrease side-effects. The clinical results of BCG have been good, with success rates of 58-100%, with a minimal follow-up of one year in prophylaxis. BCG seems superior to intravesical therapy, but at the cost of inducing more adverse effects. BCG is not indicated for low- and intermediate-risk patients, in whom chemotherapy is the first choice. BCG can also be used to eliminate tumour after an incomplete TUR, or in patients who are unfit for surgery, with a 60-70% success rate. The primary and best treatment for CIS is intravesical BCG; encouraging results have been reported, with success rate of 42-83% after a minimal follow-up of one year. Although currently BCG seems to be the choice for high-risk superficial TCC, many questions remain unanswered, especially about the mechanism(s) of action, the optimal dose and clinical schedule.
Collapse
Affiliation(s)
- N A Mungan
- Department of Urology, University Hospital, Nijmegen, The Netherlands
| | | |
Collapse
|
22
|
|
23
|
Belldegrun AS, Franklin JR, O'Donnell MA, Gomella LG, Klein E, Neri R, Nseyo UO, Ratliff TL, Williams RD. Superficial bladder cancer: the role of interferon-alpha. J Urol 1998; 159:1793-801. [PMID: 9598463 DOI: 10.1016/s0022-5347(01)63160-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE We evaluate the clinical experience with recombinant interferon-alpha in superficial transitional cell carcinoma and discuss the most rational use of recombinant interferon-alpha in the context of current treatment options. MATERIALS AND METHODS The available data were reviewed and discussed at a consensus conference in August 1996. The conclusions and recommendations are those of the authors based on the consensus reached at that meeting. RESULTS While bacillus Calmette-Guerin (BCG) is recognized as the most efficacious intravesical agent in the prophylaxis and treatment of superficial transitional cell carcinoma, it is associated with significant toxicities and a 20 to 40% relapse rate. Interferons, particularly recombinant interferon-alpha, have demonstrated efficacy against primary and recurrent papillary transitional cell carcinoma and carcinoma in situ with minimal toxicity, although the response and relapse rates are inferior to BCG. Intravesical recombinant interferon-alpha therapy has also produced responses in patients who failed to respond or were refractory to BCG or chemotherapy. CONCLUSIONS The clinical experience suggests that recombinant interferon-alpha has an important role in the treatment of superficial transitional cell carcinoma, particularly as second line therapy following failure of BCG or chemotherapy, and it may have synergistic effects when combined with chemotherapy or BCG. We propose a prospective randomized study comparing the efficacy of recombinant interferon-alpha, BCG and BCG plus recombinant interferon-alpha as maintenance following complete response to primary BCG therapy. The proposed study would also investigate the efficacy of BCG plus recombinant interferon-alpha as second line therapy following BCG failure. This study will be important to determine the most effective strategy to integrate recombinant interferon-alpha into current treatment options for superficial bladder cancer.
Collapse
Affiliation(s)
- A S Belldegrun
- Division of Urologic Oncology, UCLA School of Medicine, Los Angeles, California, USA
| | | | | | | | | | | | | | | | | |
Collapse
|