Granuloma formation in patients after injection of methanol extraction residue (MER-GCG)

Novel approach to MER/BCG administration in cancer patients

Forty-four patients with previously untreated advanced lung cancer were randomized to receive radiochemotherapy (RC) or radiochemotherapy plus MER/BCG (RCM). Prior to immunotherapy administration cutaneous reactivity to 5 log dilutions of MER/BCG was determined starting at 100 micrograms per injected site to 10 sites. Reactive patients were injected with 10, 1.0, or 0.1 micrograms while anergic patients were given 200 or 100 micrograms to each of 10 cutaneous sites, the dose being inversely related to the strength of the pretreatment reaction. Injected doses were subsequently further increased or decreased to achieve tolerable local erythema and induration. This modification resulted in a marked reduction in cutaneous toxicity previously observed, and made it possible to nearly double the mean number of MER courses per patient. It is suggested that intradermal MER/BCG may prove to be a considerably more useful therapeutic agent if doses are adjusted to patients' individual cutaneous responsiveness.