title: Efficacy of combined intravesical immunotherapy and chemotherapy for non-muscle invasive bladder cancer.
abstract: Intravesical immunotherapy using attenuated bacillus Calmette-Guérin (BCG) strains and intravesical chemotherapy are the modalities most commonly used to treat intermediate- or high-risk patients with non-muscle invasive bladder cancer. BCG has been shown to decrease recurrence rates by up to 67% compared with tumor resection alone, but intensive BCG maintenance regimens are poorly tolerated in a large proportion of patients. Intravesical chemotherapy also decreases the risk of recurrence for these patients, but has diminished efficacy compared with BCG. If BCG dose reduction can be achieved with combined intravesical immunotherapy and chemotherapy, this regimen may improve compliance and thus optimize treatment for these patients by limiting side effects from BCG monotherapy, while at the same time improving oncologic efficacy via the separate anti-tumor mechanisms of these agents. The authors discuss the most recent data regarding combining these agents in an alternating or sequential regimen.
authors.affiliation: Department of Urology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, Mail Code 7845, San Antonio, TX 78229-3900, USA.
authors.forename: William M
authors.initials: WM
authors.lastname: Hilton
authors.forename: Barbara
authors.initials: B
authors.lastname: Ercole
authors.forename: Dipen J
authors.initials: DJ
authors.lastname: Parekh
authors.forename: Guru
authors.initials: G
authors.lastname: Sonpavde
authors.forename: Rita
authors.initials: R
authors.lastname: Ghosh
authors.forename: Robert S
authors.initials: RS
authors.lastname: Svatek
mesh_terms: D000283:Administration, Intravesical; D000818:Animals; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001500:BCG Vaccine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D006801:Humans; D007167:Immunotherapy / Q000009:adverse effects / Q000379:methods*; D055118:Medication Adherence; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents; D001500:BCG Vaccine