title: Effect of keyhole limpet hemocyanin (KLH) and bacillus Calmette-Guérin (BCG) instillation on carcinoma in situ of the urinary bladder.
abstract: Patients with histologically verified carcinoma in situ (CIS) of the urinary bladder (13 primary and 8 secondary CIS) were treated with intravesical instillations of Keyhole Limpet Hemocyanin (KLH) (20 mg KLH weekly for 6 weeks, then monthly for 1 year or bimonthly for 2 subsequent years. Patients, non-responding to 2 courses of KLH were then treated with regular Bacillus Calmette-Guerin instillations (120 mg BCG-Connaught strain). The follow-up period ranged from 10 to 54 months (mean 23.5 months). 7 patients (33%) were free of tumor after the first therapeutical KLH course and 4 patients (19%) presented a complete-remission after the second KLH course (total primary response: 52%). 5 patients (24%) remained free of tumor during the established follow-up period (mean 31.7 months) and no evidence of further tumor progression occurred in patients after two courses of KLH treatment. However, 2 patients (9.5%) had to be cystectomized after KLH instillations because of progressive disease or tumor recurrence. 8 patients (38%) had to be radically cystectomized because of CIS persistence or progression after KLH and subsequent BCG treatment. Altogether 9 patients (42.8%) presented long-term remissions, with a mean duration of 31.3 months. Instillations of KLH did not induce major side effects; however, instillations of BCG caused severe dysuria in 60% and fever in 40% of patients.
authors.affiliation: Department of Urology, General Hospital Celle, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Jurincic-Winkler
authors.forename: K A
authors.initials: KA
authors.lastname: Metz
authors.forename: J
authors.initials: J
authors.lastname: Beuth
authors.forename: J
authors.initials: J
authors.lastname: Sippel
authors.forename: K F
authors.initials: KF
authors.lastname: Klippel
mesh_terms: D000276:Adjuvants, Immunologic / Q000009:adverse effects / Q000627:therapeutic use*; D000283:Administration, Intravesical; D000368:Aged; D000369:Aged, 80 and over; D001500:BCG Vaccine / Q000009:adverse effects / Q000627:therapeutic use*; D002277:Carcinoma / Q000453:epidemiology / Q000517:prevention & control / Q000601:surgery; D002278:Carcinoma in Situ / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D015653:Cystectomy; D003556:Cystitis / Q000139:chemically induced; D018450:Disease Progression; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D005334:Fever / Q000139:chemically induced; D005500:Follow-Up Studies; D006433:Hemocyanins / Q000627:therapeutic use*; D006801:Humans; D007167:Immunotherapy; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D012074:Remission Induction; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery / Q000628:therapy*
chemical_list: D000276:Adjuvants, Immunologic; D001500:BCG Vaccine; D006433:Hemocyanins; C032808:keyhole-limpet hemocyanin