[The bacillus Calmette-Guérin as immunomodulator in bladder cancer].
The bacillus Calmette-Guérin (BCG) is regarded as the most successful immunotherapy against superficial bladder carcinoma recurrences to date. BCG intravesical therapy for superficial bladder cancer has shown its efficacy and advantage over classical therapeutic strategies. This efficacy is based on complex and long lasting immune activation. The initial step is the binding of mycobacteria to the urothelial lining, which depends on the interaction of a fibronectin attachment protein on the bacteria surface with fibronectin in the bladder wall. Granulocytes and other immunocompetent mononuclear cells became attracted to the bladder wall and a cascade of proinflammatory cytokines sustains the immune response. In the bladder wall a largely TH1 based cytokine milieu and granuloma-like cellular foci are established. Within this scenario, the most important effector mechanisms might be the direct antitumor activity of interferons and the cytotoxic activity of NK cells. Current treatment consists of an induction phase of 6 weeks and a maintenance dose schedule of 3 weeks every three months up to 36. The majority of patients present adverse events related to dose administration due to bladder inflammatory response and on only a few occasions, there are mayor complications like granulomatous prostatitis. Among all the neoplasms only in superficial bladder cancer the BCG is proved to be effective.
Vázquez-Lavista
Luis Gabriel
LG
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México, D F. lugavala@yahoo.com
Flores-Balcázar
Christian Haydeé
CH
Llorente
Luis
L
D000276:Adjuvants, Immunologic / Q000009:adverse effects / Q000627:therapeutic use*; D000283:Administration, Intravesical; D001500:BCG Vaccine / Q000009:adverse effects / Q000627:therapeutic use*; D001422:Bacterial Adhesion; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000276:immunology; D003556:Cystitis / Q000209:etiology; D003602:Cytotoxicity, Immunologic; D005260:Female; D006801:Humans; D007694:Killer Cells, Natural / Q000276:immunology; D016246:Lymphocytes, Tumor-Infiltrating / Q000276:immunology; D008222:Lymphokines / Q000378:metabolism; D008297:Male; D018448:Models, Immunological; D009163:Mycobacterium bovis; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control / Q000628:therapy; D011472:Prostatitis / Q000209:etiology; D018417:Th1 Cells / Q000378:metabolism; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000276:immunology
D000276:Adjuvants, Immunologic; D001500:BCG Vaccine; D008222:Lymphokines