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Chahine R, Mendiratta-Lala M, Consul N, Wang J, Stein EB, Roseland ME, Aslam A. What can go wrong when doing right? A pictorial review of iatrogenic genitourinary complications. Abdom Radiol (NY) 2024; 49:3987-4002. [PMID: 38832944 DOI: 10.1007/s00261-024-04384-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 06/06/2024]
Abstract
A growing number of treatments for genitourinary diseases can result in various iatrogenic complications. Multimodality imaging in the post-procedural setting is essential for early and accurate diagnosis to limit morbidity and mortality. We review common and uncommon treatment-induced pathologies affecting the genitourinary system via a case-based approach. We illustrate notable complications affecting the kidneys, ureters, bladder, and urethra induced by percutaneous procedures, external beam radiation, immunotherapy, laparoscopic/robotic pelvic surgery, and intravesicular BCG. Finally, we provide guidance on optimal imaging techniques for diagnosis and highlight the role of image-guided interventions for mitigation of complications.
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Affiliation(s)
- Reve Chahine
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA.
| | - Mishal Mendiratta-Lala
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA
| | - Nikita Consul
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA
| | - Jeffrey Wang
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA
| | - Erica B Stein
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA
| | - Molly E Roseland
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA
| | - Anum Aslam
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5030, USA
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2
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Prasad SK, Raza FS, Karna S, Hoq NM, McCormick R, Sadiq A, Ibiok I, John A, Raza MM, Ahmed MH, Alsheikh M. Epididymo-Orchitis Mimicking Malignancy Resulting From Intravesical Bacillus Calmette-Guerin Immunotherapy for Bladder Cancer: An Attempt to Understand Pathophysiology, Diagnostic Challenges, Patients' Implications and Future Directions. J Med Cases 2024; 15:354-358. [PMID: 39421224 PMCID: PMC11483141 DOI: 10.14740/jmc4323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Accepted: 09/26/2024] [Indexed: 10/19/2024] Open
Abstract
This case report describes an 85-year-old patient who presented with painless, unilateral right testicular swelling of 2 months' duration. This raised the possibility of testicular cancer, especially given his recent treatment for bladder cancer, which included adjuvant intravesical bacillus Calmette-Guerin (BCG) therapy. This poses a diagnostic dilemma regarding tuberculosis (TB) of the testis, BCG complications or a true testicular malignancy. Biochemical markers and a computed tomography (CT) scan showed no evidence of malignancy or disseminated TB. A TB-ELISpot test was negative. An ultrasound of the testis revealed a hypoechoic soft tissue lesion measuring approximately 24 × 19 mm, with internal vascularity and calcifications, causing a bulge in the testicular capsule with probable extracapsular extension. Based on the clinical suspicion of a testicular tumor, a right inguinal orchidectomy was performed. Histopathologic examination revealed isolated tuberculous orchitis with focal epididymal involvement; the spermatic cord was not involved. Polymerase chain reaction (PCR) testing on the histological sample confirmed the presence of Mycobacterium bovis DNA. As a radical right orchidectomy had been performed, no abnormal tissue remained. Additionally, the CT scan showed no evidence of TB dissemination, and the patient was asymptomatic, so he was being closely monitored in the infectious disease clinic. Importantly, a urine culture became positive for TB, and he was started on antituberculosis medication. BCG-induced granulomatous epididymo-orchitis may rarely occur as a late complication following intravesical BCG therapy for superficial bladder cancer. In this case report, we attempted to understand the pathophysiology, diagnostic challenges, patient implications, and potential future research directions.
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Affiliation(s)
- Sharadchandra K. Prasad
- Department of Urology, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
| | - Fahmi Sabr Raza
- Department of Urology, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
| | - Sourabh Karna
- Department of Urology, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
| | - Nahin M. Hoq
- Department of Urology, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
| | - Robert McCormick
- Department of Urology, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
| | - Abu Sadiq
- Department of Urology, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
| | - Imoh Ibiok
- Department of Urology, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
| | - Achamma John
- Department of Pathology, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
| | - Mohammed Mansoor Raza
- Department of Infectious Diseases and Microbiology, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
| | - Mohamed H. Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
- Department of Geriatric Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
- Honorary Senior Lecturer of the Faculty of Medicine and Health Sciences, University of Buckingham, Buckingham, UK
| | - Mohammed Alsheikh
- Department of Urology, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
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Smith AA, Su H, Wallach J, Liu Y, Maiello P, Borish HJ, Winchell C, Simonson AW, Lin PL, Rodgers M, Fillmore D, Sakal J, Lin K, Vinette V, Schnappinger D, Ehrt S, Flynn JL. A "suicide" BCG strain provides enhanced immunogenicity and robust protection against Mycobacterium tuberculosis in macaques. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.11.22.568105. [PMID: 38045242 PMCID: PMC10690263 DOI: 10.1101/2023.11.22.568105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Intravenous (IV) BCG delivery provides robust protection against Mycobacterium tuberculosis (Mtb) in macaques but poses safety challenges. Here, we constructed two BCG strains (BCG-TetON-DL and BCG-TetOFF-DL) in which tetracyclines regulate two phage lysin operons. Once the lysins are expressed, these strains are killed in immunocompetent and immunocompromised mice yet induced similar immune responses and provided similar protection against Mtb challenge as wild type BCG. Lysin induction resulted in release of intracellular BCG antigens and enhanced cytokine production by macrophages. In macaques, cessation of doxycycline administration resulted in rapid elimination of BCG-TetOFF-DL. However, IV BCG-TetOFF-DL induced increased pulmonary CD4 T cell responses compared to WT BCG and provided robust protection against Mtb challenge, with sterilizing immunity in 6 of 8 macaques, compared to 2 of 8 macaques immunized with WT BCG. Thus, a "suicide" BCG strain provides an additional measure of safety when delivered intravenously and robust protection against Mtb infection.
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Affiliation(s)
- Alexander A Smith
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh PA
- The Center for Vaccine Research, University of Pittsburgh School of Medicine, Pittsburgh PA
| | - Hongwei Su
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY 10021, USA
- Present address: Center for Veterinary Science, Zhejiang University, Hangzhou, China
| | - Joshua Wallach
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Yao Liu
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Pauline Maiello
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh PA
- The Center for Vaccine Research, University of Pittsburgh School of Medicine, Pittsburgh PA
| | - H Jacob Borish
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh PA
- The Center for Vaccine Research, University of Pittsburgh School of Medicine, Pittsburgh PA
| | - Caylin Winchell
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh PA
| | - Andrew W Simonson
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh PA
- The Center for Vaccine Research, University of Pittsburgh School of Medicine, Pittsburgh PA
| | - Philana Ling Lin
- The Center for Vaccine Research, University of Pittsburgh School of Medicine, Pittsburgh PA
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Mark Rodgers
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh PA
- The Center for Vaccine Research, University of Pittsburgh School of Medicine, Pittsburgh PA
| | - Daniel Fillmore
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh PA
- The Center for Vaccine Research, University of Pittsburgh School of Medicine, Pittsburgh PA
| | - Jennifer Sakal
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh PA
- The Center for Vaccine Research, University of Pittsburgh School of Medicine, Pittsburgh PA
| | - Kan Lin
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Valerie Vinette
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Dirk Schnappinger
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Sabine Ehrt
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY 10021, USA
| | - JoAnne L Flynn
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh PA
- The Center for Vaccine Research, University of Pittsburgh School of Medicine, Pittsburgh PA
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Hartert M, Deppe C, Fink L, Kappes J. Chest wall tumor following intravesical BCG instillation for non-muscle invasive bladder cancer. J Clin Tuberc Other Mycobact Dis 2024; 35:100438. [PMID: 38623461 PMCID: PMC11017275 DOI: 10.1016/j.jctube.2024.100438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
Mycobacterium bovis bacille Calmette-Guérin (BCG) is the most effective intravesical immunotherapy for non-muscle invasive bladder cancer (NMIBC), administered after its transurethral resection. Although its instillation is generally well tolerated, BCG-related infectious complications may occur in up to 5% of patients. Clinical manifestations may arise in conjunction with initial BCG instillation or develop months or years after the last BCG instillation. The range of presentations and potential severity pose an imminent challenge for clinicians. We present a case of an isolated subcutaneous chest wall abscess in an immunocompetent 52-year-old patient nearly two years after intravesical BCG instillation for NMIBC, an absolute rarity. As the enlarging chest wall tumor may be misinterpreted as malignancy, its expedient diagnosis and prompt treatment are of critical importance.
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Affiliation(s)
- Marc Hartert
- Department of Thoracic Surgery, Katholisches Klinikum Koblenz-Montabaur, Koblenz, Germany
| | - Claudia Deppe
- Department of Internal Medicine and Pneumology, Katholisches Klinikum Koblenz-Montabaur, Koblenz, Germany
| | - Ludger Fink
- Institute of Pathology, Cytopathology, and Molecular Pathology, Supraregional Joint Practice for Pathology, Member of the German Center for Lung Research, Wetzlar, Germany
| | - Jutta Kappes
- Department of Internal Medicine and Pneumology, Katholisches Klinikum Koblenz-Montabaur, Koblenz, Germany
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5
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Salif A, Bigirimana F, Willems S, Reichman G, Noels J, Wijngaert SVD, Lecomte S, Maillart E, Clevenbergh P. Bacillus Calmette-Guérin (BCG) prostato-epididymitis in a patient treated for a non-invasive urothelial cancer: A case report. IDCases 2024; 36:e01967. [PMID: 38699528 PMCID: PMC11064455 DOI: 10.1016/j.idcr.2024.e01967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/26/2024] [Accepted: 04/14/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction The Bacillus Calmette-Guérin (BCG) used as anti-tuberculous vaccine is also a well-known therapy for superficial urothelial cancer. Local or general side effects can occur, although it is generally well tolerated. Case We present the case of a 65 year-old caucasian man consulting for gross hematuria and lower urinary tract symptoms. Magnetic resonance imaging (MRI) demonstrated a non-invasive urothelial carcinoma (NMIBC) and Prostate Imaging-Reporting and Data System (PIRADS) IV lesions. Transurethral resection of the bladder tumor revealed a non-invasive transitional cell carcinoma. Intravesical Bacillus Calmette Guerin (BCG) therapy was provided. After 6 intravesical instillations, the patient presented with prostato-epididymitis. Forthcoming BCG instillations were canceled, and cancer treatment was switched to epirubicine. Treatment with ethambutol, rifampicin and isoniazid was started with rapid resolution of the symptoms. Urinary and semen cultures grew Mycobacterium tuberculosis complex strain BCG. As prostate specific antigen (PSA) rose, prostate's biopsies were performed showing extensive necrosis boarded by granulomas without signs of malignancy. Discussion BCGitis is a rare complication in patients treated for non-invasive urothelial cancer. Several risk factors, local and systemic, should be considered prior to this immunotherapy. BCGitis (local or disseminated) or hypersensitivity reactions to BCG must be included in the differential diagnosis even if therapy was administered several years before the symptoms. Adequate treatment must be started as fast as possible to avoid serious complications.
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Affiliation(s)
- Ayemane Salif
- Department of Surgery, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium
| | - Ferdinand Bigirimana
- Department of Infectious Diseases, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium
| | - Sophie Willems
- Department of Infectious Diseases, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium
| | - Gina Reichman
- Department of Infectious Diseases, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium
| | - Johanna Noels
- Department of Infectious Diseases, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium
| | - Sigi Van Den Wijngaert
- Department of Microbiology, University Laboratory of Brussels, LHUB-ULB, Free University of Brussels, Brussels, Belgium
| | - Sophie Lecomte
- Pathology department, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium
| | - Evelyne Maillart
- Department of Infectious Diseases, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium
| | - Philippe Clevenbergh
- Department of Infectious Diseases, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium
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6
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Abou Chakra M, Moussa M, O'Donnell MA. Intravesical sequential gemcitabine/docetaxel for non-muscle invasive bladder cancer: tips and tricks for better efficacy and tolerability. J Chemother 2024:1-4. [PMID: 38439550 DOI: 10.1080/1120009x.2024.2325765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/26/2024] [Indexed: 03/06/2024]
Affiliation(s)
| | - Mohamad Moussa
- Department of Urology, Lebanese University, Al Zahraa Hospital, Beirut, Lebanon
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Bourlotos G, Baigent W, Hong M, Plagakis S, Grundy L. BCG induced lower urinary tract symptoms during treatment for NMIBC-Mechanisms and management strategies. Front Neurosci 2024; 17:1327053. [PMID: 38260019 PMCID: PMC10800852 DOI: 10.3389/fnins.2023.1327053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
Non-muscle invasive bladder cancer (NMIBC) accounts for ~70-75% of total bladder cancer tumors and requires effective early intervention to avert progression. The cornerstone of high-risk NMIBC treatment involves trans-urethral resection of the tumor followed by intravesical Bacillus Calmette-Guerin (BCG) immunotherapy. However, BCG therapy is commonly accompanied by significant lower urinary tract symptoms (LUTS) including urinary urgency, urinary frequency, dysuria, and pelvic pain which can undermine treatment adherence and clinical outcomes. Despite this burden, the mechanisms underlying the development of BCG-induced LUTS have yet to be characterized. This review provides a unique perspective on the mechanisms thought to be responsible for the development of BCG-induced LUTS by focussing on the sensory nerves responsible for bladder sensory transduction. This review focuses on how the physiological response to BCG, including inflammation, urothelial permeability, and direct interactions between BCG and sensory nerves could drive bladder afferent sensitization leading to the development of LUTS. Additionally, this review provides an up-to-date summary of the latest clinical data exploring interventions to relieve BCG-induced LUTS, including therapeutic targeting of bladder contractions, inflammation, increased bladder permeability, and direct inhibition of bladder sensory signaling. Addressing the clinical burden of BCG-induced LUTS holds significant potential to enhance patient quality of life, treatment compliance, and overall outcomes in NMIBC management. However, the lack of knowledge on the pathophysiological mechanisms that drive BCG-induced LUTS has limited the development of novel and efficacious therapeutic options. Further research is urgently required to unravel the mechanisms that drive BCG-induced LUTS.
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Affiliation(s)
- Georgia Bourlotos
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
| | - William Baigent
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
| | - Matthew Hong
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
- Urology Unit, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Sophie Plagakis
- Urology Unit, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Luke Grundy
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
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Brzezińska S, Zabost A, Borkowska-Tatar D, Klatt M, Goździk J, Dłużniewska A, Błasińska K, Augustynowicz-Kopeć E. Molecular Identification of Extrapulmonary Vaccine Adverse Events after BCG in Paraffin-Embedded Specimens. Pathogens 2023; 12:1374. [PMID: 38133259 PMCID: PMC10745674 DOI: 10.3390/pathogens12121374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/06/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
According to the World Health Organization (WHO), around 1 million children worldwide are diagnosed with tuberculosis each year. The Bacillus Calmette-Guérin (BCG) vaccine has been used around the world for over 100 years. The complications of the BCG vaccination can occur in about 0,06% of children and include local or systemic adverse reactions. Due to the close analogy between the vaccine strain and other species of the Mycobacterium tuberculosis complex (MTBC), molecular methods are recommended for differential diagnosis of Vaccine adverse events (VAE) after BCG. The ability to quickly and specifically identify BCG is important in view of different treatment regimens. The aim of the study was to assess the usefulness of genetic testing for Mycobacterium bovis BCG in the paraffin-embedded specimens' methods. We describe two cases of VAE in immune-compromised children presenting with osteoarticular changes that had been clinically suspected of tuberculosis and led to molecular identification through GeneXpert, GenoType MTBC, and Spoligotyping. Results: Mycobacterium bovis BCG was detected in osteoarticular changes embedded in paraffin block of two patients. Conclusion: Genetic tests using paraffin-embedded materials allow for quick identification and differential diagnosis of patients with Tuberculosis and VAE after BCG. This is an important issue, especially in cases where the tissue has only been submitted for histopathological examination without microbiological diagnostics for tuberculosis.
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Affiliation(s)
- Sylwia Brzezińska
- Department of Microbiology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland (D.B.-T.)
| | - Anna Zabost
- Department of Microbiology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland (D.B.-T.)
| | - Dagmara Borkowska-Tatar
- Department of Microbiology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland (D.B.-T.)
| | - Magdalena Klatt
- Department of Microbiology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland (D.B.-T.)
| | - Jolanta Goździk
- Department of Clinical Immunology and Transplantation, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | | | - Katarzyna Błasińska
- Department of Radiology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland;
| | - Ewa Augustynowicz-Kopeć
- Department of Microbiology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland (D.B.-T.)
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9
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Lee J, Yoo S, Choo MS, Cho MC, Son H, Jeong H. Prognostic Role of Preoperative Neutrophil-To-Lymphocyte Ratio (NLR) and Recurrence at First Evaluation after Bacillus Calmette-Guérin (BCG) Induction in Non-Muscle-Invasive Bladder Cancer. Diagnostics (Basel) 2023; 13:3114. [PMID: 37835857 PMCID: PMC10572862 DOI: 10.3390/diagnostics13193114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
We investigated the prognosis of BCG induction-only treatment and non-complete response (CR) at the first 3-month evaluation and examined factors associated with CR. In total, 209 patients with moderate- and high-risk NMIBC who received BCG induction-only treatment between 2008 and 2020 were retrospectively analyzed. Recurrence-free survival (RFS) and progression-free survival (PFS) were assessed based on the initial NMIBC stage. PFS and associated factors of non-CR compared to CR were also assessed. Initial T1 high-grade (HG) (n = 93) had poorer RFS and PFS after BCG induction-only treatment than Ta low-grade (LG) (p = 0.029, p = 0.002). Non-CR (n = 37) had a different neutrophil-to-lymphocyte ratio (NLR) (2.81 ± 1.02 vs. 1.97 ± 0.92) and T staging from CR (p < 0.001, p = 0.008). T1HG recurrence was associated with a worse PFS compared to non-T1HG (13.7 months vs. 101.7 months, p < 0.001). There was no difference in PFS between T1HG and T1LG. T1 and NLR were predictors of response at 3 months in multivariable analysis (p = 0.004, p = 0.029). NLR was also found to be an associated factor with RFS and PFS of bladder cancer (p < 0.001, p < 0.001). BCG induction-only treatment was effective for high-risk TaLG but not for T1HG. T1HG recurrence at 3 months after BCG induction has a poor prognosis for bladder cancer. Preoperative NLR and T1 were predictors of non-CR, and NLR was also associated with the long-term prognosis of bladder cancer.
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Affiliation(s)
- Junghoon Lee
- Department of Urology, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Republic of Korea; (J.L.)
| | - Sangjun Yoo
- Department of Urology, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Republic of Korea; (J.L.)
| | - Min Soo Choo
- Department of Urology, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Republic of Korea; (J.L.)
| | - Min Chul Cho
- Department of Urology, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Republic of Korea; (J.L.)
| | - Hwancheol Son
- Department of Urology, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Republic of Korea; (J.L.)
- Institute for Peace and Unification Studies, Seoul National University, Seoul 08826, Republic of Korea
| | - Hyeon Jeong
- Department of Urology, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Republic of Korea; (J.L.)
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10
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Magalhães JC, Sousa M, Basto R, Fraga T, Gomes I, Fernandes C, Mariano M, Paulo J, Madeira P, Sousa G. Adjuvant Hyperthermic Intravesical Chemotherapy in Intermediate- and High-Risk Non-muscle Invasive Bladder Cancer. Cureus 2023; 15:e45672. [PMID: 37745737 PMCID: PMC10512434 DOI: 10.7759/cureus.45672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 09/26/2023] Open
Abstract
INTRODUCTION Non-muscle invasive bladder cancer (NMIBC) is a frequently diagnosed neoplasm, which is typically managed with transurethral resection of bladder tumor (TURBT) eventually followed by intravesical therapies. Bacillus Calmette-Guérin (BCG) is used as first-line adjuvant treatment in high- (HR) and intermediate-risk (IR) NMIBC, although, in the latter, mitomycin C (MMC) may also be used. Multiple limitations to the use of BCG encouraged the search for therapeutic alternatives. In this context, hyperthermic intravesical chemotherapy with MMC (HIVEC-MMC) emerged as a promising therapy in the adjuvant setting for NMIBC. The aim of our study was to evaluate the tolerability, compliance, and survival outcomes of HIVEC-MMC in patients with IR- and HR-NMIBC. MATERIAL AND METHODS This was a single-center retrospective analysis of IR- and HR- NMIBC patients who received HIVEC-MMC after TURBT between August 2018 and August 2022. Levels of risk stratification were defined using the European Association of Urology (EAU) criteria. The protocol consisted of four weekly HIVEC-MMC instillations (induction) followed by six monthly instillations (maintenance). The primary outcomes were to evaluate the tolerability and compliance with the HIVEC-MMC protocol and secondary outcomes were disease-free survival (DFS) and overall survival (OS). For the purpose of statistical analysis, methods of descriptive statistics, survival analysis (Kaplan-Meier estimation), and multivariate analysis (Cox regression, and binary logistic regression) were used. RESULTS Fifty-seven patients were enrolled with a median age of 67.9 (34.4-83.5) years old. In this cohort, 40 patients (70.2%) had primary tumors. At the time of referral for HIVEC-MMC, the majority of the patients had IR-NMIBC (n= 33, 57.9%). A total of 41 patients (71.9%) completed the HIVEC-MMC protocol. Disease recurrence and adverse events (AEs) were the most common reasons to stop the protocol. After a median follow-up of 31 months (95% CI, 5.0-54.0), 32 patients (61.4%) were disease-free, 22 (38.6%) experienced recurrent disease and six patients (10.5%) died, although only one death was directly attributable to bladder cancer. The median DFS was 42 months (95% CI, 28.0-56.0). Completion of the HIVEC-MMC maintenance phase protocol stood as a predictive factor for DFS (44 months, 95% CI 29.1-58.9 vs. 14 months, 95% CI 0.0-29.6, p < 0.001; HR 4.48, 95% CI 1.65-12.15). The median OS was not reached; the 24- and 48-month OS were 92.6% and 82.7%, respectively. EAU risk group, ECOG-PS, and completion of HIVEC protocol were found to be significant predictive factors of OS but lost their significance on multivariate analysis. However, if we exclude those who experienced recurrence during the maintenance phase protocol, treatment completion had a significant positive impact on OS (HR: 42.8, 95% CI 1.75-1045.072, p= 0.021). CONCLUSIONS Our study suggests that HIVEC is a secure and well-tolerated treatment with promising efficacy data, making this therapeutic approach a feasible option in IR- and HR-NMIBC patients, mainly in those who cannot tolerate or have contraindications to BCG therapy, but also as an alternative during BCG shortages.
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Affiliation(s)
- Joana C Magalhães
- Medical Oncology, Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E., Coimbra, PRT
| | - Maria Sousa
- Medical Oncology, Centro Hospitalar Universitário do Porto, Porto, PRT
| | - Raquel Basto
- Medical Oncology, Centro Hospitalar Vila Nova de Gaia/Espinho, Gaia, PRT
| | - Teresa Fraga
- Medical Oncology, Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E., Coimbra, PRT
| | - Inês Gomes
- Medical Oncology, Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E., Coimbra, PRT
| | - Catarina Fernandes
- Medical Oncology, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Mónica Mariano
- Medical Oncology, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
| | - Judy Paulo
- Medical Oncology, Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E., Coimbra, PRT
| | - Pedro Madeira
- Medical Oncology, Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E., Coimbra, PRT
| | - Gabriela Sousa
- Medical Oncology, Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E., Coimbra, PRT
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11
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Shafique MA, Haseeb A, Siddiq MA, Mussarat A, Rangwala HS, Mustafa MS. Current and Emerging Treatments for Urothelial Carcinoma: A Focus on Enfortumab Vedotin. Cancer Manag Res 2023; 15:699-706. [PMID: 37485038 PMCID: PMC10362867 DOI: 10.2147/cmar.s418009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/17/2023] [Indexed: 07/25/2023] Open
Abstract
Urothelial carcinoma is a common malignancy that affects the urinary system, with bladder cancer being the most prevalent form. Although the management of early-stage disease has seen significant improvements, the treatment of locally advanced and metastatic urothelial carcinoma remains challenging. Over the past decade, there has been an explosion in the number of therapies available for the treatment of advanced disease, with immune checkpoint inhibitors and antibody-drug conjugates leading the way. Enfortumab vedotin is an antibody-drug conjugate that targets Nectin-4, a protein that is overexpressed in urothelial carcinoma cells. In clinical trials, it has shown promising outcomes for the treatment of advanced urothelial carcinoma that has progressed after chemotherapy or immunotherapy. The US Food and Drug Administration has granted expedited approval for enfortumab vedotin in the treatment of advanced urothelial carcinoma. This review provides an overview of the current and emerging treatments for urothelial carcinoma, with a particular focus on enfortumab vedotin. We discuss the mechanisms of action, clinical efficacy, safety, and ongoing research of enfortumab vedotin, along with the current landscape of other approved therapies and promising agents in development. The aim of this review is to provide a comprehensive and up-to-date summary of the available treatment options for urothelial carcinoma, including their limitations and future prospects.
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Affiliation(s)
| | - Abdul Haseeb
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | - Abdullah Mussarat
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
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12
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Uematsu R, Teishima J, Sakata H, Mita Y, Yoshii T, Tashiro Y, Yao A, Nakamura I. Peritoneal and pulmonary tuberculosis following intravesical administration of Bacillus Calmette-Guérin for bladder cancer. Int Cancer Conf J 2023; 12:221-225. [PMID: 37251014 PMCID: PMC10212842 DOI: 10.1007/s13691-023-00602-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 03/10/2023] [Indexed: 04/03/2023] Open
Abstract
We report a rare case of peritoneal and pulmonary tuberculosis after intravesical instillation of Bacillus Calmette-Guérin (BCG). A 76-year-old man diagnosed as high-grade urothelial carcinoma (UC) with carcinoma in situ (CIS) was treated with intravesical BCG instillation and transurethral resection of bladder tumor (TUR-BT). Three months later, TUR-BT for recurrent tumors and multiple site biopsy of bladder mucosa were performed. During TUR-BT, near perforation in the posterior wall was observed, and was disappeared after observation with urethral catheterization for 1 week. Two weeks later, he was admitted with a complaint of abdominal distention, and a computed tomography (CT) showed ascites. One week later, CT showed pleural effusion and worsening of ascites. Drainage of pleural effusion and ascites puncture was performed, and elevated adenosine deaminase (ADA) and lymphocytes count were subsequently found. In laparoscopic examination, numerous white nodules were observed in the peritoneum and omentum, and Langhans giant cells were pathologically identified in biopsy specimens. Mycobacterium culture confirmed Mycobacterium tuberculosis complex. The patient was then diagnosed with pulmonary and peritoneal tuberculosis. Anti-tuberculous agents consisting of isoniazid (INH), rifampicin (RFP), and ethambutol (EB) were administered. Six months later, a CT scan showed no evidence of pleural effusion or ascites. There has been no recurrence of either urothelial cancer or tuberculosis during follow-up for 2 years.
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Affiliation(s)
- Riku Uematsu
- Department of Urology, Kobe City Hospital Organization, Kobe City Medical Center West Hospital, 2-4 Ichibancho, Nagata-ku, Kobe, 653-0013 Japan
| | - Jun Teishima
- Department of Urology, Kobe City Hospital Organization, Kobe City Medical Center West Hospital, 2-4 Ichibancho, Nagata-ku, Kobe, 653-0013 Japan
| | - Hiroyuki Sakata
- Department of Urology, Kobe City Hospital Organization, Kobe City Medical Center West Hospital, 2-4 Ichibancho, Nagata-ku, Kobe, 653-0013 Japan
| | - Yoshie Mita
- Department of Urology, Kobe City Hospital Organization, Kobe City Medical Center West Hospital, 2-4 Ichibancho, Nagata-ku, Kobe, 653-0013 Japan
| | - Takahiko Yoshii
- Department of Urology, Kobe City Hospital Organization, Kobe City Medical Center West Hospital, 2-4 Ichibancho, Nagata-ku, Kobe, 653-0013 Japan
| | - Yuki Tashiro
- Department of Urology, Kobe City Hospital Organization, Kobe City Medical Center West Hospital, 2-4 Ichibancho, Nagata-ku, Kobe, 653-0013 Japan
| | - Akihisa Yao
- Department of Urology, Kobe City Hospital Organization, Kobe City Medical Center West Hospital, 2-4 Ichibancho, Nagata-ku, Kobe, 653-0013 Japan
| | - Ichiro Nakamura
- Department of Urology, Kobe City Hospital Organization, Kobe City Medical Center West Hospital, 2-4 Ichibancho, Nagata-ku, Kobe, 653-0013 Japan
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13
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Hahn NM, O'Donnell MA, Efstathiou JA, Zahurak M, Rosner GL, Smith J, Kates MR, Bivalacqua TJ, Tran PT, Song DY, Baras AS, Matoso A, Choi W, Smith KN, Pardoll DM, Marchionni L, McGuire B, Grace Phelan M, Johnson BA, O'Neal T, McConkey DJ, Rose TL, Bjurlin M, Lim EA, Drake CG, McKiernan JM, Deutsch I, Anderson CB, Lamm DL, Geynisman DM, Plimack ER, Hallman MA, Horwitz EM, Al-Saleem E, Chen DYT, Greenberg RE, Kutikov A, Guo G, Masterson TA, Adra N, Kaimakliotis HZ. A Phase 1 Trial of Durvalumab in Combination with Bacillus Calmette-Guerin (BCG) or External Beam Radiation Therapy in Patients with BCG-unresponsive Non-muscle-Invasive Bladder Cancer: The Hoosier Cancer Research Network GU16-243 ADAPT-BLADDER Study. Eur Urol 2023; 83:486-494. [PMID: 36717286 PMCID: PMC10192088 DOI: 10.1016/j.eururo.2023.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 12/09/2022] [Accepted: 01/09/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Novel treatments and trial designs remain a high priority for bacillus Calmette-Guerin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC) patients. OBJECTIVE To evaluate the safety and preliminary efficacy of anti-PD-L1 directed therapy with durvalumab (D), durvalumab plus BCG (D + BCG), and durvalumab plus external beam radiation therapy (D + EBRT). DESIGN, SETTING, AND PARTICIPANTS A multicenter phase 1 trial was conducted at community and academic sites. INTERVENTION Patients received 1120 mg of D intravenously every 3 wk for eight cycles. D + BCG patients also received full-dose intravesical BCG weekly for 6 wk with BCG maintenance recommended. D + EBRT patients received concurrent EBRT (6 Gy × 3 in cycle 1 only). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Post-treatment cystoscopy and urine cytology were performed at 3 and 6 -mo, with bladder biopsies required at the 6-mo evaluation. The recommended phase 2 dose (RP2D) for each regimen was the primary endpoint. Secondary endpoints included toxicity profiles and complete response (CR) rates. RESULTS AND LIMITATIONS Twenty-eight patients were treated in the D (n = 3), D + BCG (n = 13), and D + EBRT (n = 12) cohorts. Full-dose D, full-dose BCG, and 6 Gy fractions × 3 were determined as the RP2Ds. One patient (4%) experienced a grade 3 dose limiting toxicity event of autoimmune hepatitis. The 3-mo CR occurred in 64% of all patients and in 33%, 85%, and 50% within the D, D + BCG, and D + EBRT cohorts, respectively. Twelve-month CRs were achieved in 46% of all patients and in 73% of D + BCG and 33% of D + EBRT patients. CONCLUSIONS D combined with intravesical BCG or EBRT proved feasible and safe in BCG-unresponsive NMIBC patients. Encouraging preliminary efficacy justifies further study of combination therapy approaches. PATIENT SUMMARY Durvalumab combination therapy can be safely administered to non-muscle-invasive bladder cancer patients with the goal of increasing durable response rates.
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Affiliation(s)
- Noah M Hahn
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA; The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA; The James Buchanan Brady Urological Institute, Baltimore, MD, USA.
| | | | - Jason A Efstathiou
- Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Marianna Zahurak
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Gary L Rosner
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Jeff Smith
- Hoosier Cancer Research Network, Indianapolis, IN, USA
| | - Max R Kates
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA; The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA; The James Buchanan Brady Urological Institute, Baltimore, MD, USA
| | - Trinity J Bivalacqua
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA; The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA; The James Buchanan Brady Urological Institute, Baltimore, MD, USA; Division of Urology and Urologic Surgery, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Phuoc T Tran
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA; The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA; The James Buchanan Brady Urological Institute, Baltimore, MD, USA; Department of Radiation Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Daniel Y Song
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA; The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA; The James Buchanan Brady Urological Institute, Baltimore, MD, USA; Department of Radiation Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Alex S Baras
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA; The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA; The James Buchanan Brady Urological Institute, Baltimore, MD, USA; Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Andres Matoso
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA; The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA; The James Buchanan Brady Urological Institute, Baltimore, MD, USA; Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Woonyoung Choi
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA; The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA; The James Buchanan Brady Urological Institute, Baltimore, MD, USA
| | - Kellie N Smith
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA; The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA; Johns Hopkins Bloomberg Kimmel Institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Drew M Pardoll
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA; The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA; Johns Hopkins Bloomberg Kimmel Institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Luigi Marchionni
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA; The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Center for Computational Genomics, Baltimore, MD, USA; Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Bridget McGuire
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA; The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA; The James Buchanan Brady Urological Institute, Baltimore, MD, USA
| | - Mary Grace Phelan
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA; The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA; The James Buchanan Brady Urological Institute, Baltimore, MD, USA
| | - Burles A Johnson
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA; The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA; The James Buchanan Brady Urological Institute, Baltimore, MD, USA
| | - Tanya O'Neal
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - David J McConkey
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA; The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA; The James Buchanan Brady Urological Institute, Baltimore, MD, USA
| | - Tracy L Rose
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; Division of Medical Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Marc Bjurlin
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; Department of Urology, University of North Carolina, Chapel Hill, NC, USA
| | - Emerson A Lim
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA; Spectrum Health Medical Group, Grand Rapids, MI, USA
| | - Charles G Drake
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA; Janssen Research and Development, Springhouse, PA, USA
| | - James M McKiernan
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA; Department of Urology, Columbia University, New York, NY, USA
| | - Israel Deutsch
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA; Department of Radiation Oncology, Columbia University, New York, NY, USA
| | - Christopher B Anderson
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA; Department of Urology, Columbia University, New York, NY, USA
| | | | - Daniel M Geynisman
- Department of Hematology and Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Elizabeth R Plimack
- Department of Hematology and Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Mark A Hallman
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Essel Al-Saleem
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - David Y T Chen
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | - Alexander Kutikov
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Gordon Guo
- Department of Radiation Oncology, Indiana University Simon Cancer Center, Indianapolis, IN, USA; University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Timothy A Masterson
- Department of Urology, Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - Nabil Adra
- Division of Hematology and Oncology, Indiana University Simon Cancer Center, Indianapolis, IN, USA
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14
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Tominaga Y, Fujii M, Sadahira T, Katayama S, Iwata T, Nishimura S, Bekku K, Edamura K, Kobayashi T, Kobayashi Y, Kiura K, Maeda Y, Wada K, Araki M. Bladder tuberculosis with ureteral strictures after bacillus Calmette‑Guérin therapy for urinary bladder cancer: A case report. Mol Clin Oncol 2022; 18:7. [PMID: 36761388 PMCID: PMC9886853 DOI: 10.3892/mco.2022.2603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
Intravesical immunotherapy using bacillus Calmette-Guérin (BCG) is recommended for patients with intermediate- to high-risk non-muscle invasive bladder cancer. Bladder tuberculosis (TB) is a rare complication of BCG therapy. The present study describes the case of a 73-year-old man who underwent intravesical BCG therapy for urothelial carcinoma in situ of the bladder. Red patches around the resection scar were first detected 1 year and 5 months after BCG treatment; these findings gradually spread to encompass more of the bladder wall. Transurethral biopsy revealed a benign lesion, but the patient developed bilateral hydronephrosis and mild voiding dysfunction. The patient was eventually diagnosed with bladder TB by mycobacterial urine culture and TB-specific polymerase chain reaction (PCR). The patient was given multidrug therapy (isoniazid, rifampicin and ethambutol) and their bladder TB was completely cured; however, their voiding dysfunction and bilateral hydronephrosis did not fully improve. Bladder TB can occur long after intravesical BCG administration and cystoscopy findings consistent with inflammation can be the key to suspecting this condition. Acid-fast examination and PCR testing of a urine sample are necessary for early diagnosis.
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Affiliation(s)
- Yusuke Tominaga
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Masanori Fujii
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama 700-8558, Japan
| | - Takuya Sadahira
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan,Correspondence to: Dr Takuya Sadahira, Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan NULL
| | - Satoshi Katayama
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Takehiro Iwata
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Shingo Nishimura
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Kensuke Bekku
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Kohei Edamura
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Tomoko Kobayashi
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Yasuyuki Kobayashi
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Katsuyuki Kiura
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama 700-8558, Japan
| | - Yoshinobu Maeda
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama 700-8558, Japan
| | - Koichiro Wada
- Department of Urology, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan
| | - Motoo Araki
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
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15
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Muacevic A, Adler JR, Reid GE, Arif A, Adams E. Systemic Bacillus Calmette-Guerin Infection One Year After Intravesical Immunotherapy Mimicking Sarcoidosis. Cureus 2022; 14:e31697. [PMID: 36561593 PMCID: PMC9767275 DOI: 10.7759/cureus.31697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2022] [Indexed: 11/21/2022] Open
Abstract
A patient presented with pancytopenia and hypercalcemia after intravesical immunotherapy with Bacillus Calmette-Guerin (BCG) for bladder cancer. Bone marrow biopsy performed six months later revealed noncaseating granulomas with negative stains for AFB. He was diagnosed with sarcoidosis and treated with prednisone. Hypercalcemia resolved, but mild pancytopenia persisted. One year later, he developed sepsis. Blood cultures six weeks later grew Mycobacterium tuberculosis complex, ultimately identified as Mycobacterium bovis. Despite triple antibiotic therapy, the patient progressively declined and expired.
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16
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Castellano E, Samba C, Esteso G, Simpson L, Vendrame E, García‐Cuesta EM, López‐Cobo S, Álvarez-Maestro M, Linares A, Leibar A, Ranganath T, Reyburn HT, Martínez‐Piñeiro L, Blish C, Valés‐Gómez M. CyTOF analysis identifies unusual immune cells in urine of BCG-treated bladder cancer patients. Front Immunol 2022; 13:970931. [PMID: 36189320 PMCID: PMC9520259 DOI: 10.3389/fimmu.2022.970931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
High grade non-muscle-invasive bladder tumours are treated with transurethral resection followed by recurrent intravesical instillations of Bacillus Calmette Guérin (BCG). Although most bladder cancer patients respond well to BCG, there is no clinical parameter predictive of treatment response, and when treatment fails, the prognosis is very poor. Further, a high percentage of NMIBC patients treated with BCG suffer unwanted effects that force them to stop treatment. Thus, early identification of patients in which BCG treatment will fail is really important. Here, to identify early stage non-invasive biomarkers of non-responder patients and patients at risk of abandoning the treatment, we longitudinally analysed the phenotype of cells released into the urine of bladder cancer patients 3-7 days after BCG instillations. Mass cytometry (CyTOF) analyses revealed a large proportion of granulocytes and monocytes, mostly expressing activation markers. A novel population of CD15+CD66b+CD14+CD16+ cells was highly abundant in several samples; expression of these markers was confirmed using flow cytometry and qPCR. A stronger inflammatory response was associated with increased cell numbers in the urine; this was not due to hematuria because the cell proportions were distinct from those in the blood. This pilot study represents the first CyTOF analysis of cells recruited to urine during BCG treatment, allowing identification of informative markers associated with treatment response for sub-selection of markers to confirm using conventional techniques. Further studies should jointly evaluate cells and soluble factors in urine in larger cohorts of patients to characterise the arms of the immune response activated in responders and to identify patients at risk of complications from BCG treatment.
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Affiliation(s)
- Eva Castellano
- Department of Immunology and Oncology, National Centre for Biotechnology (CNB) Spanish National Research Council (CSIC), Madrid, Spain
| | - Célia Samba
- Department of Immunology and Oncology, National Centre for Biotechnology (CNB) Spanish National Research Council (CSIC), Madrid, Spain
| | - Gloria Esteso
- Department of Immunology and Oncology, National Centre for Biotechnology (CNB) Spanish National Research Council (CSIC), Madrid, Spain
| | - Laura Simpson
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Elena Vendrame
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Eva M. García‐Cuesta
- Department of Immunology and Oncology, National Centre for Biotechnology (CNB) Spanish National Research Council (CSIC), Madrid, Spain
| | - Sheila López‐Cobo
- Department of Immunology and Oncology, National Centre for Biotechnology (CNB) Spanish National Research Council (CSIC), Madrid, Spain
| | - Mario Álvarez-Maestro
- Urology Department, La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
- Urology Unit, Infanta Sofia Hospital, Madrid, Spain
| | - Ana Linares
- Urology Unit, Infanta Sofia Hospital, Madrid, Spain
| | - Asier Leibar
- Urology Unit, Infanta Sofia Hospital, Madrid, Spain
| | - Thanmayi Ranganath
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Hugh T. Reyburn
- Department of Immunology and Oncology, National Centre for Biotechnology (CNB) Spanish National Research Council (CSIC), Madrid, Spain
| | - Luis Martínez‐Piñeiro
- Urology Department, La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
- Urology Unit, Infanta Sofia Hospital, Madrid, Spain
| | - Catherine Blish
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
- Chan Zuckerberg Biohub, San Francisco, CA, United States
| | - Mar Valés‐Gómez
- Department of Immunology and Oncology, National Centre for Biotechnology (CNB) Spanish National Research Council (CSIC), Madrid, Spain
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
- *Correspondence: Mar Valés‐Gómez,
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Eley SJ, Fatima S, Barlev D, Rohr BR. Discrete red-brown crusted papules with a bladder cancer history. JAAD Case Rep 2022; 29:161-163. [PMID: 36267646 PMCID: PMC9576529 DOI: 10.1016/j.jdcr.2022.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Sarah J. Eley
- College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio
| | - Sakeena Fatima
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Danny Barlev
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Bethany R. Rohr
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Correspondence to: Bethany R. Rohr, MD, University Hospitals Department of Dermatology, 11100 Euclid Ave, Cleveland, OH 44106.
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18
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Yildirim R, Cansu DÜ, Korkmaz C. A Case of Scleromyxedema Development Following Intravesical Bacillus Calmette-Guérin Administration. J Rheumatol 2022; 49:858-859. [PMID: 35169063 DOI: 10.3899/jrheum.211010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Reşit Yildirim
- Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey.
| | - Döndü Üsküdar Cansu
- Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Cengiz Korkmaz
- Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
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Severe Respiratory Failure Due to Pulmonary BCGosis in a Patient Treated for Superficial Bladder Cancer. Diagnostics (Basel) 2022; 12:diagnostics12040922. [PMID: 35453970 PMCID: PMC9026867 DOI: 10.3390/diagnostics12040922] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 12/13/2022] Open
Abstract
Intra-vesical instillations with bacillus Calmette-Guerin (BCG) are the established adjuvant therapy for superficial bladder cancer. Although generally safe and well tolerated, they may cause a range of different, local, and systemic complications. We present a patient treated with BCG instillations for three years, who was admitted to our hospital due to fever, hemoptysis, pleuritic chest pain and progressive dyspnea. Chest computed tomography (CT) showed massive bilateral ground glass opacities, partly consolidated, localized in the middle and lower parts of the lungs, bronchial walls thickening, and bilateral hilar lymphadenopathy. PCR tests for SARS-CoV-2 as well as sputum, blood, and urine for general bacteriology—were negative. Initial empiric antibiotic therapy was ineffective and respiratory failure progressed. After a few weeks, a culture of M. tuberculosis complex was obtained from the patient’s specimens; the cultured strain was identified as Mycobacterium bovis BCG. Anti-tuberculous treatment with rifampin (RMP), isoniazid (INH) and ethambutol (EMB) was implemented together with systemic corticosteroids, resulting in the quick improvement of the patient’s clinical condition. Due to hepatotoxicity and finally reported resistance of the BCG strain to INH, levofloxacin was used instead of INH with good tolerance. Follow-up CT scans showed partial resolution of the pulmonary infiltrates. BCG infection in the lungs must be taken into consideration in every patient treated with intra-vesical BCG instillations and symptoms of protracted infection.
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Metzen M, Kowar M, Solleder G, Wilhelm K, Jacobs AH. [BCG-therapy as a rare reason for postrenal failure]. Dtsch Med Wochenschr 2022; 147:403-406. [PMID: 35345047 DOI: 10.1055/a-1766-3235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
HISTORY AND CLINICAL FINDINGS In the following case report, we describe a patient with acute renal failure due to an urinary congestion level II-III under BCG-(Bacillus Calmette-Guérin)-therapy because of bladder cancer. Cystoscopy revealed the diagnosis of BCG-induced intramural narrowing of distal ureters bilaterally. THERAPY AND FURTHER DEVELOPMENT After receiving a double-J-catheter the renal function returned to normal. CONCLUSIONS Although postrenal failure is relatively rare (5 %), also seldom causes such as medication-induced (e. g. BCG) ureter stenosis has to be included into the differential diagnosis.
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Affiliation(s)
- Maike Metzen
- Klinik für Geriatrie mit Neurologie und Tagesklinik, Johanniter-Krankenhaus Bonn
| | - Michael Kowar
- Klinik für Geriatrie mit Neurologie und Tagesklinik, Johanniter-Krankenhaus Bonn
| | | | - Kai Wilhelm
- Altersmedizinisches Zentrum der Johanniter-Kliniken Bonn
| | - Andreas H Jacobs
- Klinik für Geriatrie mit Neurologie und Tagesklinik, Johanniter-Krankenhaus Bonn
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21
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Audenet F, Sotto A, Roumiguié M, Allory Y, Andrejak C, Leon P, Loriot Y, Masson-Lecomte A, Pradère B, Seisen T, Traxer O, Xylinas E, Bruyère F, Roupret M, Saint F, Neuzillet Y. Recommandations des Comités de cancérologie (CC-AFU) et d’infectiologie (CI-AFU) de l’Association française d’urologie pour la prise en charge effets indésirables et complications du BCG. Prog Urol 2022; 32:165-176. [DOI: 10.1016/j.purol.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/02/2022] [Accepted: 01/10/2022] [Indexed: 12/01/2022]
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22
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Nguyen KG, Wagner ES, Vrabel MR, Mantooth SM, Meritet DM, Zaharoff DA. Safety and Pharmacokinetics of Intravesical Chitosan/Interleukin-12 Immunotherapy in Murine Bladders. Bladder Cancer 2021; 7:427-437. [PMID: 38993985 PMCID: PMC11181725 DOI: 10.3233/blc-211542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/30/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Intravesical administration of interleukin 12 (IL-12) co-formulated with the biopolymer, chitosan (CS/IL-12), has demonstrated remarkable antitumor activity against preclinical models of bladder cancer. However, given historical concerns regarding severe toxicities associated with systemic IL-12 administration in clinical trials, it is important to evaluate the safety of intravesical CS/IL-12 prior to clinical translation. OBJECTIVE To evaluate the pharmacokinetics as well as the local and systemic toxicities of intravesical CS/IL-12 immunotherapy in laboratory mice. METHODS Local inflammatory responses in mouse bladders treated with intravesical IL-12 or CS/IL-12 were assessed via histopathology. Serum cytokine levels following intravesical and subcutaneous (s.c.) administrations of IL-12 or CS/IL-12 in laboratory mice were compared. Systemic toxicities were evaluated via body weight and liver enzyme levels. RESULTS Intravesical IL-12 and CS/IL-12 treatments did not induce significant local or systemic toxicity. IL-12 dissemination and exposure from intravesical administration was significantly lower compared to s.c. injections. Weekly intravesical CS/IL-12 treatments were well-tolerated and did not result in blunted immune responses. CONCLUSIONS Intravesical CS/IL-12 is safe and well-tolerated in mice. In particular, the lack of cystitis and acute inflammation justifies continued investigation of intravesical CS/IL-12 immunotherapy in larger animals and patients with bladder cancer.
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Affiliation(s)
- Khue G. Nguyen
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina-Chapel Hill, Raleigh, NC, USA
| | - Ethan S. Wagner
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina-Chapel Hill, Raleigh, NC, USA
| | - Maura R. Vrabel
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina-Chapel Hill, Raleigh, NC, USA
| | - Siena M. Mantooth
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina-Chapel Hill, Raleigh, NC, USA
| | - Danielle M. Meritet
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - David A. Zaharoff
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina-Chapel Hill, Raleigh, NC, USA
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23
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Oliveira AA, Morais J, Ribeiro J, Gouveia PF. Systemic infection following intravesical therapy with BCG. BMJ Case Rep 2021; 14:e243641. [PMID: 34753717 PMCID: PMC8578936 DOI: 10.1136/bcr-2021-243641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/03/2022] Open
Abstract
Immunotherapy with BCG is an effective and widely used treatment for non-muscle-invasive bladder cancer. BCG sepsis is a rare but life-threatening and frequently not a straightforward complication of this treatment; in cases with a high index of suspicion, anti-bacillary treatment should not wait for laboratory confirmation and be instituted immediately. We report a severe case of BCG sepsis, in which timely diagnosis and initiation of antituberculosis agents enabled a full recovery.
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Affiliation(s)
| | - Joana Morais
- Department of Internal Medicine, Hospital de Braga, Braga, Portugal
| | - Jorge Ribeiro
- Department of Urology, Hospital de Braga, Braga, Portugal
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24
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Mitra D, Bhatnagar A, Suhag D, Sandhu S. A Rare Case Report of BCG Induced Balanitis in a Patient with Transitional Cell Carcinoma of Urinary Bladder. Indian Dermatol Online J 2021; 12:745-749. [PMID: 34667763 PMCID: PMC8456258 DOI: 10.4103/idoj.idoj_158_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/11/2021] [Accepted: 05/13/2021] [Indexed: 11/04/2022] Open
Abstract
Primary Bacillus Calmette-Guérin (BCG) infection of the glans penis is not a very common entity and has been rarely reported in literature. BCG has been used as an adjuvant therapy in patients of transitional cell urinary bladder carcinoma following transurethral resection of bladder tumor. We report a 66-year-old male patient who was being managed for urinary bladder carcinoma with nine sittings of adjuvant BCG therapy. He developed painless swelling with multiple pustules over glans penis and prepuce along with inguinal lymphadenopathy. He had a BCG inoculation scar over his arm and his chest X-ray was within normal limits. His workup for sexually transmitted disease was negative. The biopsy from the nodule on prepuce revealed mixed inflammatory infiltrate comprising of neutrophils, lymphocytes, and eosinophils along with numerous congested blood vessels and hemosiderin macrophages. Mycobacterium tuberculosis gene expert from tissue was positive for acid fast bacilli (AFB). Fine-needle aspiration cytology from the right inguinal lymph node also revealed AFB on Ziehl-Neelsen stain. The BCG immunotherapy was stopped and the patient was started on a standard four-drug antitubercular therapy comprising isoniazid, rifampicin, ethambutol, and pyrazinamide along with daily doses of pyridoxine. The edema resolved and papules subsided within 2 weeks after starting antitubercular therapy. This is a very rare presentation although intravesical BCG therapy is a very common treatment modality, hence this report is intended to increase awareness of this condition in dermatologists and venereologists.
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Affiliation(s)
- Debdeep Mitra
- Department of Dermatology, Command Hospital Air Force, Bangalore, Karnataka, India
| | - Anuj Bhatnagar
- Department of Dermatology, Command Hospital Air Force, Bangalore, Karnataka, India
| | - Devinder Suhag
- Department of Dermatology, Command Hospital Air Force, Bangalore, Karnataka, India
| | - Sunmeet Sandhu
- Department of Dermatology, Command Hospital Air Force, Bangalore, Karnataka, India
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25
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Vallilas C, Zachou M, Dolkiras P, Sakellariou S, Constantinou CA, Flevari P, Anastasopoulou A, Androutsakos T. Difficulties in Diagnosing and Treating Disseminated Bacillus Calmette-Guérin (BCG) Infection After Intravesical BCG Therapy in a Patient with Liver Cirrhosis: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933006. [PMID: 34654796 PMCID: PMC8525903 DOI: 10.12659/ajcr.933006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Patient: Male, 62-year-old
Final Diagnosis: BCGitis
Symptoms: Fever • general fatigue
Medication: —
Clinical Procedure: Bone marrow biopsy • liver biopsy
Specialty: Infectious Diseases • General and Internal Medicine
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Affiliation(s)
- Christos Vallilas
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Zachou
- Department of Gastroenterology, Sismanoglio General Hospital, Athens, Greece
| | | | - Stratigoula Sakellariou
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Pagona Flevari
- Thalassemia and Sickle Cell Disease Center, Laiko General Hospital, Athens, Greece
| | | | - Theodoros Androutsakos
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athnes, Greece
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26
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Sun K, Wang D, Wu G, Ma J, Wang T, Wu J, Wang J. Mirabegron improves the irritative symptoms caused by BCG immunotherapy after transurethral resection of bladder tumors. Cancer Med 2021; 10:7534-7541. [PMID: 34547193 PMCID: PMC8559481 DOI: 10.1002/cam4.4278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aims to explore the efficacy and safety of mirabegron in treating irritative symptoms induced by intravesical immunotherapy with Bacillus Calmette-Guerin (BCG) after transurethral resection of bladder tumors (TURBT). METHODS A total of 160 patients subjected to TURBT was randomly divided into the mirabegron group and placebo group with 80 patients in each group. Then, the patients were administered 25 mg mirabegron or placebo daily, starting the first day after BCG infusion. The first BCG perfusion was conducted at least 2 weeks after TURBT. The 3-day bladder diaries were completed in all patients, 1 day before BCG perfusion, and on the 1st, 6th, and 13th days after the first BCG perfusion. Overactive bladder symptom scores were completed 1 day before BCG perfusion, and on the 6th and 13th days after the first BCG perfusion. RESULTS Symptom scores of bladder hyperactivity were significantly different between the two groups (p < 0.001). Also, the frequency of nocturia, pollakiuria, micturition urgency, urinary incontinence and was significantly lower in group 1 than that in group two (p < 0.05). CONCLUSION Our findings demonstrate that mirabegron is a valuable clinical drug for the management of irritative symptoms after TURBT with subsequent intravesical BCG perfusion.
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Affiliation(s)
- Kai Sun
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Di Wang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Gang Wu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Jian Ma
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Tianqi Wang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Jitao Wu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Jipeng Wang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
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27
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Lange C, Aaby P, Behr MA, Donald PR, Kaufmann SHE, Netea MG, Mandalakas AM. 100 years of Mycobacterium bovis bacille Calmette-Guérin. THE LANCET. INFECTIOUS DISEASES 2021; 22:e2-e12. [PMID: 34506734 DOI: 10.1016/s1473-3099(21)00403-5] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 12/13/2022]
Abstract
Mycobacterium bovis bacille Calmette-Guérin (BCG), an experimental vaccine designed to protect cattle from bovine tuberculosis, was administered for the first time to a newborn baby in Paris in 1921. Over the past century, BCG has saved tens of millions of lives and has been given to more humans than any other vaccine. It remains the sole tuberculosis vaccine licensed for use in humans. BCG provides long-lasting strong protection against miliary and meningeal tuberculosis in children, but it is less effective for the prevention of pulmonary tuberculosis, especially in adults. Evidence mainly from the past two decades suggests that BCG has non-specific benefits against non-tuberculous infections in newborn babies and in older adults, and offers immunotherapeutic benefit in certain malignancies such as non-muscle invasive bladder cancer. However, as a live attenuated vaccine, BCG can cause localised or disseminated infections in immunocompromised hosts, which can also occur following intravesical installation of BCG for the treatment of bladder cancer. The legacy of BCG includes fundamental discoveries about tuberculosis-specific and non-specific immunity and the demonstration that tuberculosis is a vaccine-preventable disease, providing a foundation for new vaccines to hasten tuberculosis elimination.
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Affiliation(s)
- Christoph Lange
- Division of Clinical Infectious Diseases, Medical Clinic, Research Center Borstel, Borstel, Germany; German Center for Infection Research (DZIF) Tuberculosis Unit, Borstel, Germany; Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany; Global TB Program, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
| | - Peter Aaby
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau; Bandim Health Project, Southern Danish University, Copenhagen, Denmark
| | - Marcel A Behr
- McGill International TB Centre and Department of Medicine, McGill University, Montreal, QC, Canada
| | - Peter R Donald
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stefan H E Kaufmann
- Max Planck Institute for Infection Biology, Berlin, Germany; Max Planck Institute for Biophysical Chemistry, Göttingen, Germany; Hagler Institute for Advanced Study, Texas A&M University, College Station, TX, USA
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands; Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Anna M Mandalakas
- Global TB Program, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
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28
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Plasek J, Weissert J, Downs T, Richards K, Ravvaz K. Clinicopathological Criteria Predictive of Recurrence Following Bacillus Calmette-Guérin Therapy Initiation in Non-Muscle-Invasive Bladder Cancer: Retrospective Cohort Study. JMIR Cancer 2021; 7:e25800. [PMID: 34156341 PMCID: PMC8277393 DOI: 10.2196/25800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 01/31/2023] Open
Abstract
Background Bacillus Calmette-Guérin (BCG) is currently the most clinically effective intravesical treatment for non–muscle-invasive bladder cancer (NMIBC), particularly for patients with high-risk NMIBC such as those with carcinoma in situ. BCG treatments could be optimized to improve patient safety and conserve supply by predicting BCG efficacy based on tumor characteristics or clinicopathological criteria. Objective The aim of this study is to assess the ability of specific clinicopathological criteria to predict tumor recurrence in patients with NMIBC who received BCG therapy along various treatment timelines. Methods A total of 1331 patients (stage Ta, T1, or carcinoma in situ) who underwent transurethral resection of a bladder tumor between 2006 and 2017 were included. Univariate analysis, including laboratory tests (eg, complete blood panels, creatinine levels, and hemoglobin A1c levels) within 180 days of BCG therapy initiation, medications, and clinical and demographic variables to assess their ability to predict NMIBC recurrence, was completed. This was followed by multivariate regression that included the elements of the Club Urológico Español de Tratamiento Oncológico (CUETO) scoring model and variables that were significant predictors of recurrence in univariate analysis. Results BCG was administered to 183 patients classified as intermediate or high risk, and 76 (41.5%) experienced disease recurrence. An abnormal neutrophil-to-lymphocyte ratio measured within 180 days of induction BCG therapy was a significant predictor (P=.047) of future cancer recurrence and was a stronger predictor than the CUETO score or the individual variables included in the CUETO scoring model through multivariate analysis. Conclusions An abnormal neutrophil-to-lymphocyte ratio within 180 days of BCG therapy initiation is predictive of recurrence and could be suggestive of additional or alternative interventions.
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Affiliation(s)
- Joseph Plasek
- Advocate Aurora Research Institute, Milwaukee, WI, United States
| | - John Weissert
- Advocate Aurora Research Institute, Milwaukee, WI, United States
| | - Tracy Downs
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Kyle Richards
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Kourosh Ravvaz
- Advocate Aurora Research Institute, Milwaukee, WI, United States
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29
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Topuz B, Zor M, Yılmaz S, Kaya E. Uncommon adverse events of intravesical Bacillus Calmette-Guérin treatment: A report of three cases. REVISTA ESPANOLA DE QUIMIOTERAPIA 2021; 34:383-386. [PMID: 33956411 PMCID: PMC8329566 DOI: 10.37201/req/155.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - M Zor
- Murat ZOR, Gulhane Research and Training Hospital, Department of Urology, 06010 Etlik, Ankara, Turkey.
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30
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Abdelghani KB, Nacef L, Miladi S, Sellami M, Ouenniche K, Souabni L, Kassab S, Chekili S, Fazaa A, Laatar A. Reactive Arthritis following Bacillus Calmette-Guerin Therapy for Bladder Cancer: a Systematic Literature Review. Curr Rheumatol Rep 2021; 23:39. [PMID: 33913026 DOI: 10.1007/s11926-021-01004-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Intravesical BCG therapy (ivBCG) is a treatment for bladder cancer that complements surgery and prevents tumor progression. Reactive arthritis (ReA) is a rare osteoarticular manifestation that can complicate this treatment. An updated systematic literature review has been investigated to identify clinical, biological, and therapeutic data of this pathology. RECENT FINDINGS A systematic literature was performed on October 2020 to identify papers published from 2000 to 2020. Study eligibility criteria included case reports, case series, cohort studies, systematic reviews, meta-analysis, and letters to the editor, in English and French. Independent extraction of articles was performed by two investigators. Thirteen studies met the search criteria for the systematic review with a good quality assessment. The total number of patients was 107, with an average age of 61.5 [24-80]. The symptoms of ReA appeared after a mean number of 5.71 instillations and 13.9 days. Arthritis was the most common symptom (98.13%) followed by fever (80.76%) and conjunctivitis (64.42%). Human leukocyte antigen (HLAB27) was positive in 28.97% of patients. Therapeutic modalities included non-steroidal anti-inflammatory drugs (NSAIDs) (51.4%), corticosteroids (27.1%), conventional synthetic disease-modifying antirheumatic drugs (3.84%), antitubercular drugs (14.42%), and tocilizumab (0.93%). BCG therapy was discontinued in 29.9% of patients. Remission was achieved in 92.3% of patients and one patient progressed to spondyloarthritis. ReA is a rare complication of BCG therapy. Clinical signs are similar to those of typical ReA and treatment is primarily based on NSAIDs and corticosteroids.
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Affiliation(s)
| | - Lilia Nacef
- Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia.
| | - Saoussen Miladi
- Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia
| | - Meriem Sellami
- Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia
| | - Kmar Ouenniche
- Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia
| | - Leila Souabni
- Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia
| | - Selma Kassab
- Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia
| | - Selma Chekili
- Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia
| | - Alia Fazaa
- Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia
| | - Ahmed Laatar
- Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia
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31
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Stern R, Roscoe C, Misch EA. Mycobacterium bovis BCG osteoarticular infection complicating immune therapy for bladder cancer: a case report. J Bone Jt Infect 2021; 6:107-110. [PMID: 34084698 PMCID: PMC8129905 DOI: 10.5194/jbji-6-107-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/04/2021] [Indexed: 11/11/2022] Open
Abstract
Osteoarticular infection with Mycobacterium bovis (M. bovis) is a rare complication of bladder cancer
treatment with intravesical Bacillus Calmette–Guèrin (BCG). We describe
a case of disseminated Mycobacterium bovis BCG infection masquerading as a chronic prosthetic
joint infection in a patient with several risk factors for progressive
mycobacterial infection.
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Affiliation(s)
- Rebecca Stern
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Clay Roscoe
- Family Medicine Residency of Idaho, Boise, Idaho, United States
| | - Elizabeth A Misch
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
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Low LS, Scholtz D, Leyland J, Nair SM. A severe complication of intravesical bacillus Calmette-Guerin: An effect of different strains. Urol Case Rep 2021; 36:101592. [PMID: 33598408 PMCID: PMC7868797 DOI: 10.1016/j.eucr.2021.101592] [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: 01/13/2021] [Revised: 01/27/2021] [Accepted: 01/30/2021] [Indexed: 11/26/2022] Open
Abstract
The use of intravesical BCG has improved the survival and outcomes in the treatment of bladder cancer. However, the worldwide shortage of OncoTice BCG has caused disruption and changes in treatment regimes, leading to use of alternative strains. We describe a severe complication as the result of using intravesical SII Onco BCG for the treatment bladder cancer, in an 82 year old man presenting with granulomatous epididymo-orchitis.
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Affiliation(s)
- Li Sian Low
- Urology Department, Level B1, Waikato Hospital, Hamilton, New Zealand
| | - David Scholtz
- Urology Department, Level B1, Waikato Hospital, Hamilton, New Zealand
| | - John Leyland
- Urology Department, Level B1, Waikato Hospital, Hamilton, New Zealand
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BCG infection (BCGitis) following intravesical instillation for bladder cancer and time interval between treatment and presentation: A systematic review. Urol Oncol 2020; 39:85-92. [PMID: 33308969 DOI: 10.1016/j.urolonc.2020.11.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/23/2020] [Accepted: 11/22/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Intravesical Bacillus Calmette-Guèrin (BCG) is an effective treatment in non--muscle-invasive bladder cancer, however, extravesical BCG infection may occur in remote organs as a potentially serious complication. Researchers aimed to assess whether a different timing of BCG infection after intravesical administration of BCG could be identified and estimated for each single involved organ. METHODS We performed a systematic literature review over systemic and genitourinary BCG infection case reports, including 271 published case reports for a total of 307 patients. Demographic data, clinical features, and timing of BCG infection development were collected and analyzed for each patient. RESULTS BCG infection developed with a different timing from last instillation, depending on the involved organ. Among the genitourinary complications, penile lesions occurred as early as 1 (1;3) weeks, while orchiepididymitis occurred as late as 56 (6.25;156) weeks. At the same time, granulomatous hepatitis and lungs involvement such as miliary pulmonary BCG infection occurred earlier, with a median time of 1 (1;4) and 1 (1;6) weeks respectively, whereas vascular, osteoarticular, and muscular complications developed with a median timing from last instillation of 52 (20;104), 68 (14;156), and 93 (29;156) weeks, respectively. The analysis detected a cluster between lungs, liver, and bone marrow complications on one side and muscular and osteoarticular or vascular complications on the other side was also observed. CONCLUSIONS BCG infection after intravesical BCG for bladder cancer may develop even several months or years after the last instillation, depending on the involved organs. When BCG infection interests one or more organ, 2 main associative patterns are common: one involving lungs, liver, and bone marrow, with earlier occurrence but lower rates of microbiological diagnosis achievement, and one involving muscular and osteoarticular or vascular districts, with later occurrence but higher rates of microbiological evidence.
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Testicular tuberculosis: An uncommon complication after treatment of urothelial carcinoma. Radiol Case Rep 2020; 15:2285-2293. [PMID: 32983302 PMCID: PMC7494947 DOI: 10.1016/j.radcr.2020.07.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/11/2020] [Accepted: 07/12/2020] [Indexed: 11/24/2022] Open
Abstract
Tuberculous epididymo-orchitis is an uncommon complication after intravesical bacilli Calmette-Guerin therapy for nonmuscle invasive bladder cancer. Spread of granulomatous disease through the genitourinary tract specifically to the testes occurs in 0.4% of treated patients. The following case presents a 77-year-old man who underwent intravesical therapy after transurethral resection of bladder tumor and developed testicular discomfort and a palpable mass 2 years after initiation of therapy. After wide range of serum and urine analyses, repeated testicular ultrasonography, and an unsuccessful course of antibiotics, the patient elected to undergo orchiectomy and was confirmed to have tuberculous epididymo-orchitis. Diagnosis based on imaging and laboratory serum and urine analysis may be elusive and therefore review of this entity and associated sonographic findings is discussed.
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Schmitz L, Berdien B, Huland E, Dase P, Beutel K, Fisch M, Engel O. The Impact of a New Interleukin-2-Based Immunotherapy Candidate on Urothelial Cells to Support Use for Intravesical Drug Delivery. Life (Basel) 2020; 10:life10100231. [PMID: 33027905 PMCID: PMC7601792 DOI: 10.3390/life10100231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/19/2020] [Accepted: 10/02/2020] [Indexed: 12/01/2022] Open
Abstract
(1) Background: The intravesical instillation of interleukin-2 (IL-2) has been shown to be very well tolerated and promising in patients with bladder malignancies. This study aims to confirm the use of a new IL-2 containing immunotherapy candidate as safe for intravesical application. IL-2, produced in mammalian cells, is glycosylated, because of its unique solubility and stability optimized for intravesical use. (2) Materials and Methods: Urothelial cells and fibroblasts were generated out of porcine bladder and cultured until they reached second passage. Afterwards, they were cultivated in renal epithelial medium (REM) and Dulbecco’s modified Eagles medium (DMEM) with the IL-2 candidate (IMS-Research) and three more types of human interleukin-2 immunotherapy products (IMS-Pure, Natural IL-2, Aldesleukin) in four different concentrations (100, 250, 500, 1000 IU/mL). Cell proliferation was analyzed by water soluble tetrazolium (WST) proliferation assay after 0, 3, and 6 days for single cell culture and co-culture. (3) Results: Proliferation assays showed that all IL-2 products induced very similar cultivation results and none of the IL-2 variants had a negative impact on the proliferation of urothelial cells and fibroblast in either concentration. (4) Conclusion: Human recombinant glycosylated IL-2 as well as human non-glycosylated IL-2 have no negative influence on the tissue cell proliferation of porcine urothelial cells and fibroblasts in vitro and represent a promising and innovative potential intravesical therapy candidate for patients in high need.
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Affiliation(s)
- Lisa Schmitz
- Department of Urology, University Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany; (P.D.); (K.B.); (M.F.); (O.E.)
- Correspondence:
| | | | - Edith Huland
- Immunservice GmbH, 20251 Hamburg, Germany; (B.B.); (E.H.)
| | - Petra Dase
- Department of Urology, University Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany; (P.D.); (K.B.); (M.F.); (O.E.)
| | - Karin Beutel
- Department of Urology, University Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany; (P.D.); (K.B.); (M.F.); (O.E.)
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany; (P.D.); (K.B.); (M.F.); (O.E.)
| | - Oliver Engel
- Department of Urology, University Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany; (P.D.); (K.B.); (M.F.); (O.E.)
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Trained immunity as a molecular mechanism for BCG immunotherapy in bladder cancer. Nat Rev Urol 2020; 17:513-525. [PMID: 32678343 DOI: 10.1038/s41585-020-0346-4] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 01/01/2023]
Abstract
Intravesical BCG instillation is the gold-standard adjuvant immunotherapy for patients with high-risk non-muscle-invasive bladder cancer. However, the precise mechanism of action by which BCG asserts its beneficial effects is still unclear. BCG has been shown to induce a non-specific enhancement of the biological function in cells of the innate immune system, creating a de facto heterologous immunological memory that has been termed trained immunity. Trained immunity or innate immune memory enables innate immune cells to mount a more robust response to secondary non-related stimuli after being initially primed (or trained) by a challenge such as BCG. BCG-induced trained immunity is characterized by the metabolic rewiring of monocyte intracellular metabolism and epigenetic modifications, which subsequently lead to functional reprogramming effects, such as an increased production of cytokines, on restimulation. Results from BCG vaccination studies in humans show that trained immunity might at least partly account for the heterologous beneficial effects of BCG vaccination. Additionally, immunity might have a role in the effect of BCG immunotherapy for bladder cancer. Based on these indications, we propose that trained immunity could be one of the important mechanisms mediating BCG immunotherapy and could provide a basis for further improvements towards a personalized approach to BCG therapy in non-muscle-invasive bladder cancer.
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Darlington CD, Mammen RJ, Mammen KJ. COVID-19 and its impact on genitourinary malignancies. Indian J Urol 2020; 36:163-170. [PMID: 33082630 PMCID: PMC7531365 DOI: 10.4103/iju.iju_167_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 04/20/2020] [Accepted: 05/25/2020] [Indexed: 12/11/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 has emerged as an alarming disease since December 2019, claiming the lives of thousands across the world to date. This pandemic has burdened healthcare systems all over the world due to its heavy death toll. Researchers are actively working on effective treatment strategies, the scope of vaccination and the production of more medical equipment to tackle this crisis. However, it is important to note that the management of patients with malignancy also needs to be prioritized during such times. Some urological malignancies need early diagnosis and treatment while the diagnosis and treatment of several others can be safely delayed. Hence, we searched MEDLINE for evidence on the optimal management of urological cancers during the coronavirus disease (COVID-19) pandemic. Studies published from December 2019 to April 2020 were included in the review. Guidelines formulated by international and national urological societies were also included. This review aims to summarize the present evidence on effective triage and safe management of urological cancers amid COVID-19 pandemic to ensure efficient usage of healthcare resources during these unprecedented times.
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Affiliation(s)
- C. Danny Darlington
- Department of Urology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Rohan J. Mammen
- Department of Urology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Kim J. Mammen
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Waked R, Choucair J, Chehata N, Haddad E, Saliba G. Intravesical Bacillus Calmette-Guérin (BCG) treatment's severe complications: A single institution review of incidence, presentation and treatment outcome. J Clin Tuberc Other Mycobact Dis 2020; 19:100149. [PMID: 32099909 PMCID: PMC7016447 DOI: 10.1016/j.jctube.2020.100149] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Intravesical Bacillus Calmette-Guérin (BCG) treatment for superficial bladder cancer is interrupted in approximatively 8% of cases as a result of complications. The objective is to report the severe related complications of Bacillus Calmette-Guérin (BCG) following an intravesical instillation for bladder tumor encountered at our institution for the past 5 years. METHODS Medical records of a tertiary teaching hospital, located in Beirut, Lebanon, were retrospectively analyzed from June 2014 to June 2019 searching for severe related complications of BCG. A comprehensive review of articles on this subject was conducted. RESULTS The incidence of severe systemic adverse events related to BCG instillation was 1.5% (5 out of 332 patients). A total of five patients were found to have a severe BCG related complication, with fever, chills, and irritative urinary signs being the most frequent symptoms. All patients received antituberculosis therapy (Isoniazid, Rifampin and Ethambutol). Two were put on add-on corticosteroids. Three patients had a computed tomography scan image in favor of an infection. Two patients had a favorable outcome, three patients died. CONCLUSION BCG severe adverse events were mostly seen in patients with a traumatic instillation. Treatment used at our institution was similar to most cases reported in the literature. A standardized diagnostic and treatment approach should be implemented to help physicians tackle these life-threatening complications.
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Affiliation(s)
- R. Waked
- Department of Infectious Diseases, Faculty of Medicine, Saint Joseph University, Damascus street, PO BOX 11-5076, Riad El Solh, Beirut 1107 2180, Lebanon
| | - J. Choucair
- Coordinator of the Infectious Diseases department, Saint Joseph University, Beirut, Lebanon
| | - N. Chehata
- Department of Infectious Diseases, Faculty of Medicine, Saint Joseph University, Damascus street, PO BOX 11-5076, Riad El Solh, Beirut 1107 2180, Lebanon
| | - E. Haddad
- Department of Infectious Diseases, Faculty of Medicine, Saint Joseph University, Damascus street, PO BOX 11-5076, Riad El Solh, Beirut 1107 2180, Lebanon
| | - G. Saliba
- Department of Infectious Diseases, Faculty of Medicine, Saint Joseph University, Damascus street, PO BOX 11-5076, Riad El Solh, Beirut 1107 2180, Lebanon
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Bach-Griera M, Campo-Pérez V, Barbosa S, Traserra S, Guallar-Garrido S, Moya-Andérico L, Herrero-Abadía P, Luquin M, Rabanal RM, Torrents E, Julián E. Mycolicibacterium brumae Is a Safe and Non-Toxic Immunomodulatory Agent for Cancer Treatment. Vaccines (Basel) 2020; 8:E198. [PMID: 32344808 PMCID: PMC7349652 DOI: 10.3390/vaccines8020198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 12/11/2022] Open
Abstract
Intravesical Mycobacterium bovis Bacillus Calmette-Guérin (BCG) immunotherapy remains the gold-standard treatment for non-muscle-invasive bladder cancer patients, even though half of the patients develop adverse events to this therapy. On exploring BCG-alternative therapies, Mycolicibacterium brumae, a nontuberculous mycobacterium, has shown outstanding anti-tumor and immunomodulatory capabilities. As no infections due to M. brumae in humans, animals, or plants have been described, the safety and/or toxicity of this mycobacterium have not been previously addressed. In the present study, an analysis was made of M. brumae- and BCG-intravenously-infected severe combined immunodeficient (SCID) mice, M. brumae-intravesically-treated BALB/c mice, and intrahemacoelic-infected-Galleria mellonella larvae. Organs from infected mice and the hemolymph from larvae were processed to count bacterial burden. Blood samples from mice were also taken, and a wide range of hematological and biochemical parameters were analyzed. Finally, histopathological alterations in mouse tissues were evaluated. Our results demonstrate the safety and non-toxic profile of M. brumae. Differences were observed in the biochemical, hematological and histopathological analysis between M. brumae and BCG-infected mice, as well as survival curves rates and colony forming units (CFU) counts in both animal models. M. brumae constitutes a safe therapeutic biological agent, overcoming the safety and toxicity disadvantages presented by BCG in both mice and G. mellonella animal models.
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Affiliation(s)
- Marc Bach-Griera
- Departament de Genètica i de Microbiologia, Facultat de Biociències, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (M.B.-G.); (V.C.-P.); (S.G.-G.); (P.H.-A.); (M.L.)
| | - Víctor Campo-Pérez
- Departament de Genètica i de Microbiologia, Facultat de Biociències, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (M.B.-G.); (V.C.-P.); (S.G.-G.); (P.H.-A.); (M.L.)
- Bacterial Infections and Antimicrobial Therapies group, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), 08028 Barcelona, Spain; (L.M.-A.); (E.T.)
| | - Sandra Barbosa
- Department of Cell Biology, Physiology and Immunology, Facultat de Veterinària, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (S.B.); (S.T.)
- Integrated Services of Laboratory Animals, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Sara Traserra
- Department of Cell Biology, Physiology and Immunology, Facultat de Veterinària, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (S.B.); (S.T.)
- Integrated Services of Laboratory Animals, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Sandra Guallar-Garrido
- Departament de Genètica i de Microbiologia, Facultat de Biociències, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (M.B.-G.); (V.C.-P.); (S.G.-G.); (P.H.-A.); (M.L.)
| | - Laura Moya-Andérico
- Bacterial Infections and Antimicrobial Therapies group, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), 08028 Barcelona, Spain; (L.M.-A.); (E.T.)
| | - Paula Herrero-Abadía
- Departament de Genètica i de Microbiologia, Facultat de Biociències, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (M.B.-G.); (V.C.-P.); (S.G.-G.); (P.H.-A.); (M.L.)
| | - Marina Luquin
- Departament de Genètica i de Microbiologia, Facultat de Biociències, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (M.B.-G.); (V.C.-P.); (S.G.-G.); (P.H.-A.); (M.L.)
| | - Rosa Maria Rabanal
- Unitat de Patologia Murina i Comparada, Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain;
| | - Eduard Torrents
- Bacterial Infections and Antimicrobial Therapies group, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), 08028 Barcelona, Spain; (L.M.-A.); (E.T.)
- Microbiology Section, Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, 643 Diagonal Ave., 08028 Barcelona, Spain
| | - Esther Julián
- Departament de Genètica i de Microbiologia, Facultat de Biociències, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (M.B.-G.); (V.C.-P.); (S.G.-G.); (P.H.-A.); (M.L.)
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Guallar-Garrido S, Julián E. Bacillus Calmette-Guérin (BCG) Therapy for Bladder Cancer: An Update. Immunotargets Ther 2020; 9:1-11. [PMID: 32104666 PMCID: PMC7025668 DOI: 10.2147/itt.s202006] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 01/28/2020] [Indexed: 01/02/2023] Open
Abstract
Physicians treating patients affected by nonmuscle-invasive bladder cancer (NMIBC) have been in shock during the last six years since manufacturing restrictions on the production of the first-option medicine, Mycobacterium bovis Bacillus Calmette-Guérin (BCG), have resulted in worldwide shortages. This shortage of BCG has led to a rethinking of the established treatment guidelines for the rationing of the administration of BCG. Some possible schedule modifications consist of a decrease in the length of maintenance treatment, a reduction in the dose of BCG in intravesical instillations or the use of different BCG substrains. All these strategies have been considered valuable in times of BCG shortage. In addition, the lack of availability of BCG has also led to the general recognition of the need to find new treatment options for these patients so that they are not dependent on a single treatment. Few alternatives are committed to definitively replacing BCG intravesical instillations, but several options are being evaluated to improve its efficacy or to combine it with other chemotherapeutic or immunotherapeutic options that can also improve its effect. In this article, we review the current state of the treatment with BCG in terms of all of the aforementioned aspects.
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Affiliation(s)
- Sandra Guallar-Garrido
- Departament de Genètica i de Microbiologia, Facultat de Biociències, Universitat Autònoma de Barcelona, Bellaterra (Barcelona), Spain
| | - Esther Julián
- Departament de Genètica i de Microbiologia, Facultat de Biociències, Universitat Autònoma de Barcelona, Bellaterra (Barcelona), Spain
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Krajewski W, Poletajew S. Enhanced power bacillus Calmette-Guérin-possibly too much of a good thing. Transl Androl Urol 2020; 8:S461-S462. [PMID: 32042616 DOI: 10.21037/tau.2019.10.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Wojciech Krajewski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Sławomir Poletajew
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
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