A randomized trial of intravesical doxorubicin and immunotherapy with bacille Calmette-Guerin for transitional-cell carcinoma of the bladder

Article Abstract:

Immunotherapy using bacille Calmette-Guerin (BCG) is an approved treatment for carcinoma in situ (early stage cancer) of the bladder, and its superiority over surgery alone and as a preventive agent has been shown in several randomized, controlled trials. However, randomized studies have not been carried out to compare the effectiveness of BCG with that of chemotherapeutic drugs such as doxorubicin (known to prevent tumor recurrence). A study was conducted of 262 patients with either rapidly recurrent (131 patients) or in situ transitional-cell carcinoma of the bladder. Patients were treated prophylactically if they were tumor-free, and therapeutically if they had carcinoma in situ. They were randomly assigned to receive either BCG or doxorubicin in the bladder, with the option of changing to the other treatment if recurrence took place. Patients were followed-up for a median time of 65 months, with treatment effectiveness evaluated by biopsy and urinalysis. Treatment with BCG was associated with a greater number of adverse effects, few of which were severe; the number of at least moderate effects was similar in the two groups. BCG treatment led to a greater proportion (70 percent) of complete responses (complete disappearance of disease) than doxorubicin (34 percent) in patients with carcinoma in situ, and a complete response was seen sooner after treatment started with BCG. Recurrences, when seen, took place after 5.1 months (median value) in doxorubicin patients and after 39 months in BCG patients. Those who received BCG had a probability, after five years, of disease-free survival of 45 percent, compared with 18 percent after doxorubicin. Patients with tumors without carcinoma in situ had a probability of disease-survival at five years of 37 percent with BCG and of 17 percent with doxorubicin, and a time to treatment failure of 10.4 months and 22.5 months, respectively. These findings, which include results from 46 medical institutions, indicate that BCG is no more toxic than standard chemotherapy and that it can be administered safely and effectively. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Development and progression, Drug therapy, Doxorubicin

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A 57-year-old man with fever and jaundice after intravesical instillation of Bacille Calmette-Guerin for bladder cancer

Article Abstract:

A 57-year-old man was admitted to a hospital with fever and jaundice. He had been diagnosed with bladder cancer several years earlier and received regular treatments with Bacille Calmette-Guerin (BCG). BCG is a live strain of bacteria similar to the tuberculosis bacteria. It is usually infused into the bladder using a urinary catheter. Diagnostic tests indicated that he had hepatitis but he had no known exposure to the hepatitis viruses. His physicians suspected that the BCG infusions had caused the hepatitis, and this was confirmed by a liver biopsy.

Causes of, Complications and side effects, Hepatitis

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Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer

Article Abstract:

Patients with metastatic renal cell cancer who have the kidney removed and also take interferon alfa-2b have longer survival rates than those who only take interferon alfa-2b. Metastatic renal cell cancer is kidney cancer that has spread to other parts of the body.

Health aspects, Interferon alpha, Carcinoma, Renal cell, Renal cell carcinoma

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