scholarly journals Disseminated BCG: Complications of Intravesical Bladder Cancer Treatment

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Uyen To ◽  
Joyce Kim ◽  
David Chia
Keyword(s):  
Bladder Cancer ◽  
Hypersensitivity Pneumonitis ◽  
Superficial Bladder Cancer ◽  
Transitional Cell ◽  
Low Grade ◽  
Newly Diagnosed ◽  
Insidious Onset ◽  
Initial Symptoms ◽  
Intravesical Bcg ◽  
Carcinoma Of The Bladder

Intravesical bacillus Calmette-Guerin (BCG) has been established as an effective treatment of superficial bladder cancer (Parker and Kommu, 2013). However, major side effects, including pneumonitis, sepsis, and even death, may occur in <5% of patients (Gonzalez et al., 2003). Here we present a case of severe disseminatedMycobacterium bovisfollowing intravesical BCG administration. Our patient is a 76-year-old gentleman with newly diagnosed superficial transitional cell carcinoma of the bladder who recently received his first intravesical BCG treatment. He initially presented with hemoptysis and was found to have extensive patchy infiltrates bilaterally. He was treated for pneumonia with antibiotics and then with steroids for hypersensitivity pneumonitis but continued to deteriorate. Due to the temporal proximity of his exposure to BCG, we administered treatment for presumed disseminated BCG infection with rifampin, isoniazid, and ethambutol. Within a 48-hour period, the patient improved dramatically. The reported cases of infection from intravesical BCG illustrate an insidious onset with initial symptoms of low-grade fevers and cystitis but may progress to pneumonitis. If the symptoms persist for more than 7 days or if there is clinical deterioration, RIPE therapy (with rifampin, isoniazid, pyridoxine, and ethambutol) and a fluoroquinolone should be administered for a 6–9-month course along with steroids for 4–6 weeks (Naudžiunas et al., 2012).

Adaptive genetic algorithms combined with high sensitivity single cell-based technology derived urine-based score to differentiate between high-grade and low-grade transitional cell carcinoma of the bladder.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 572-572
Author(s):  
Shaheen Riadh Alanee ◽  
Zade Roumayah ◽  
Musatafa Deebajah ◽  
James O. Peabody ◽  
Rodrigo Mora ◽  
...  
Keyword(s):  
Flow Cytometry ◽  
Bladder Cancer ◽  
Single Cell ◽  
Transitional Cell ◽  
Low Grade ◽  
High Grade ◽  
Median Score ◽  
Adaptive Genetic Algorithms ◽  
Cell Flow Cytometry ◽  
Carcinoma Of The Bladder

572 Background: We previously showed that adaptive genetic algorithms (AGA), in combination with single-cell flow cytometry technology, can be used to develop a noninvasive urine-based score to detect bladder cancer with high accuracy. Our aim in this analysis was to investigate if that same score can differentiate between high grade (HG) and low grade (LG) transitional cell carcinoma of the bladder (BC). Methods: We collected urine samples from cystoscopy confirmed HG and LG superficial bladder cancer patients and healthy donors in an optimized urine collection media. We then examined these samples using an assay developed from AGA in combination with single-cell flow cytometry technology. Results: We examined 50 BC and 15 healthy donor urine samples. Patients were majorly White (59.2%), males (61.2%), and had HG BC (66.7%). AGA derived score of 1.1 differentiated between BCa and healthy patients with high precision (AUC 0.92). The median score was 2.8 for LG BC and 6 for LG BC. Mann-Whitney Rank Sum Test indicated that the difference between the median score of HG and LG BC was significant at P value = 0.003. The score performed well independent of patients’ sex or smoking history. Conclusions: Using single-cell technology and machine learning, we developed a new urine-based score that can potentially differentiate between HG and LG bladder cancer. Future studies are planned to validate this score.

scholarly journals Analysis of Japanese Patients Treated with or without Long-Term Epirubicin Plus Ara-C Intravesical Instillation Therapy for Low-Grade Superficial Bladder Cancer

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Tomonori Kato ◽  
Kazushi Nomura ◽  
Fukuo Kondo ◽  
Masami Wakisaka ◽  
Akira Komiya
Keyword(s):  
Bladder Cancer ◽  
Tumor Recurrence ◽  
Superficial Bladder Cancer ◽  
Transitional Cell ◽  
Japanese Patients ◽  
Intravesical Instillation ◽  
Intravesical Chemotherapy ◽  
Low Grade ◽  
Free Rate

The high incidence of tumor recurrence following transurethral resection (TUR) represents a major problem encountered in the management of bladder cancer. This study examined the efficacy of intravesical chemotherapy in superficial bladder cancer. We retrospectively analyzed 90 Japanese cases with low-grade superficial transitional cell carcinoma (stage T1, grades 1 and 2) who were rendered tumor-free by TURBT (TUR of bladder tumor) and who thereafter were treated with or without intravesical chemotherapy. Among them, instillation was terminated in 2 patients due to adverse effects (severe but reversible chemical cystitis). Remaining 88 patients were divided into 2 groups according to therapy: the TURBT-only group(n=46), defined as patients treated with TURBT alone, and the Instillation group(n=42), defined as patients treated with weekly intravesical instillation therapies using epirubicin plus Ara-C. Recurrence-free rate was significantly higher in the Instillation group than in the TURBT-only group (p=0.02, HR = 0.457). The 5-year recurrence-free rate was 58.5% for the Instillation group and 38.6% for the TURBT-only group. Our instillation schedule represents the most intensive regimen among previously reported therapies and resulted in a 54.3% decrease in incidence of tumor recurrence. We believe that the results of this study could provide useful information on management of bladder cancer.

scholarly journals Recurrence rate of superficial bladder cancer with intravesical BCG and mitomycin.

2021 ◽  
Vol 28 (06) ◽  
pp. 854-860
Author(s):  
Khalid Hussain ◽  
Muhammad Asif ◽  
Farooq Malik ◽  
Munazza Yasmeen ◽  
Maria Tariq ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Mitomycin C ◽  
Recurrence Rate ◽  
Superficial Bladder Cancer ◽  
Controlled Trial ◽  
Transitional Cell ◽  
Female Ratio ◽  
Intravesical Bcg ◽  
Group A ◽  
Group B

Objective: To compare the recurrence rate of superficial transitional cell carcinoma of urinary bladder using intravesical BCG and Mitomycin-C. Study Design: Randomized Controlled Trial. Setting: Urology Department, Teaching DHQ Hospital, Gujranwala. Period: November 2018, to Sep, 2019. Material & Methods: Was carried out on total 270 patients, admitted with suspicion of urothelial tumors. They were grouped in Group A and B, comprising 135 in each group. Group A received BCG and Group B received Mtiomycin-C intravesically following TUR-BT. Results: Out of 270 patients male to female ratio was 3:1. Age range of patients was between 30 to 70 years with mean of 50.0± 13.1 and 552.3 ± 12.9 years in Group A and B respectively. Recurrence was noted in 05.38% and 15.38% patients in Group A and B respectively. Regarding side effects pyrexia was associated with BCG in 27.40% patients which were self-limited in 26.66% cases however required anti-tuberculosis therapy for six months in 0.74%. Whereas only 06.67% patients receiving Mitomycin had pyrexia. Dysuria occurred in 74% and frequency in 68% patients who received BCG. Whereas Dysuria occurred in 20% and frequency in 36.29% patients who received Mitomycin-C. However genital skin rash was more common (08.14%) in Mitomycin group than BCG. Conclusion: Keeping in mind less recurrence rate and bearable toxicity, it is concluded that BCG is superior to Mitomycin. This study suggests long term follow up is required to establish recurrence in the management of superficial bladder cancer.

Complications of Bacillus Calmette-Guerin immunotherapy in superficial bladder cancer

1995 ◽  
Vol 62 (1_suppl) ◽  
pp. 91-93 ◽  
Author(s):  
E. Vestita ◽  
A. Manassero ◽  
C. Terrone ◽  
S. Rocca Rossetti
Keyword(s):  
Bladder Cancer ◽  
Standard Treatment ◽  
Superficial Bladder Cancer ◽  
Transitional Cell ◽  
Delayed Type Hypersensitivity ◽  
Bacterial Cells ◽  
Specific Therapy ◽  
Intravesical Bcg

— Intravesical immunotherapy with BCG has become a standard treatment of superficial recurrent transitional cell carcinoma and in-situ bladder carcinoma. Studies on the mechanism of action have demonstrated the role of T lymphocytes. Moreover clinical and experimental results suggest a role by cytochines and delayed type hypersensitivity. BCG, while effective in the treatment of bladder cancer, has a defined morbidity that can be ascribed to the fact that it consists of viable bacterial cells. We evaluated the complications and side effects of this therapy in 71 patients who had received intravesical BCG (Pasteur strain BCG was instilled weekly for 6 weeks, fortnightly for three months and monthly for 12 months at a dose of 75 mg). Our findings showed the following complications: cystitis (63.3%), hematuria (28.1%), fever (7%), two cases of pruritus (2.8%), one case of hepatitis with persistent fever. Granulomatous prostatitis was noted in four cases (5.6%), a higher incidence than reported in literature, but it is a localized and self-limiting process that does not require specific therapy. In conclusion, the treatment with intravesical BCG has a significant morbidity, but the rate of complications is low and most need no treatment.

Superficial bladder cancer: the primacy of grade in the development of invasive disease.

1987 ◽  
Vol 5 (1) ◽  
pp. 125-130 ◽  
Author(s):  
F M Torti ◽  
B L Lum ◽  
D Aston ◽  
N MacKenzie ◽  
M Faysel ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Logistic Regression ◽  
Superficial Bladder Cancer ◽  
Medical Center ◽  
Bladder Wall ◽  
Transitional Cell ◽  
Invasive Disease ◽  
Deep Muscle ◽  
Carcinoma Of The Bladder ◽  
Muscle Invasion

Tumor characteristics thought to predict for development of deep muscle invasion after resection of superficial bladder cancer were retrospectively analyzed in 252 patients with transitional cell carcinoma of the bladder at Stanford University Medical Center. Stage 0 patients accounted for 190 of the patient population (75.5%), while stage A and B1 comprised 51 (20%) and 11 (4.5%), respectively. The median follow-up time was 62 months. Forty-three patients subsequently developed deep muscle invasion; these included 24 (12.6%), 14 (27.5%), and 5 (45.5%) of stage 0, A, and B1 patients (P = .002), or 15 (10%), 15 (9%), and 13 (33%) of grade 1, 2, and 3 tumors (P = .001), respectively. When analyzed by univariate logistic regression, grade (P = .0001) and stage (P = .0118) were significant predictors for invasive disease. Site of tumor and number of tumors at presentation were not significant factors for invasion deep into the bladder wall. When multiple logistic regression was performed, only grade remained as a significant tumor variable to predict for invasive disease (P less than .0091). Risk of invasive disease did not appear to increase with increasing number of recurrences, remaining at approximately an 11% invasion rate through 12 recurrences. In this analysis, grade was the most significant tumor variable in superficial bladder cancer predicting for the development of invasive carcinoma. Future clinical trials for definitive or adjuvant therapy of this disease must stratify for this variable.

Intravesical Gemcitabine Therapy for Superficial Transitional Cell Carcinoma of the Bladder: A Phase I and Pharmacokinetic Study

2003 ◽  
Vol 21 (4) ◽  
pp. 697-703 ◽  
Author(s):  
Menachem Laufer ◽  
Sakkaraiappan Ramalingam ◽  
Mark P. Schoenberg ◽  
Mary Ellen Haisfield-Wolf ◽  
Eleanor G. Zuhowski ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Superficial Bladder Cancer ◽  
Transitional Cell ◽  
Maximum Tolerated Dose ◽  
Intravesical Therapy ◽  
Systemic Absorption ◽  
Therapy Failure ◽  
Low Concentrations ◽  
Transitional Cell Bladder Carcinoma ◽  
Carcinoma Of The Bladder

Purpose: To determine maximum-tolerated dose, toxicities, and pharmacokinetics associated with weekly intravesical gemcitabine therapy in patients with superficial bladder cancer. Patients and Methods: Fifteen patients with recurrent superficial transitional cell bladder carcinoma who experienced prior intravesical therapy failure were studied. Two to 4 weeks after complete transurethral resection, gemcitabine was administered intravesically, once weekly for 6 consecutive weeks. Dwell time was 2 hours. Pharmacokinetics of gemcitabine and its metabolite, 2′2′-difluorodeoxyuridine (dFdU), were studied in plasma and urine. Cystoscopy was repeated 6 weeks after therapy. Results: Three-patient cohorts were enrolled sequentially at doses of 500, 1,000, and 1,500 mg in 100 mL 0.9% NaCl. Two patients received 2,000 mg in 100 mL. An additional four patients received 2,000 mg in 50 mL. No grade 4 toxicity or clinically relevant myelosuppression was noted. Nine of 13 evaluable patients were recurrence-free at 12 weeks. Low concentrations of gemcitabine (≤ 1 μg/mL) were present transiently in plasma of all patients receiving 2,000 mg in 50 mL. Gemcitabine was undetectable in plasma of other patients. dFdU was undetectable in plasma of patients receiving less than 1,500 mg. At doses ≥ 1,500 mg, dFdU concentrations increased until 90 to 120 minutes and then declined little, if any. Plasma dFdU concentrations implied absorption of 0.5% to 5.5% of instilled dose. Between 61% and 100% of the gemcitabine dose was accounted for in voided urine. No dFdU was measured in voided urine. Conclusion: Intravesical gemcitabine, at doses up to 2 g/wk, is well tolerated, is associated with minimal systemic absorption, and has promising efficacy in treatment of superficial bladder cancer.

Correlation of deoxyribonucleic acid content and failure of superficial bladder cancer treatment with Bacillus Calmette-Guerin

1995 ◽  
Vol 62 (4) ◽  
pp. 540-544
Author(s):  
N. Rodrigues Netto ◽  
C.A. Levi D'Ancona ◽  
F.E. Venco ◽  
R. El Ibrahim ◽  
M.J.B. Rodrigues Netto
Keyword(s):  
Bladder Cancer ◽  
Transitional Cell Carcinoma ◽  
Cell Carcinoma ◽  
Deoxyribonucleic Acid ◽  
Superficial Bladder Cancer ◽  
Tumour Progression ◽  
Transitional Cell ◽  
Initial Therapy ◽  
Bcg Therapy ◽  
Intravesical Bcg

The purpose is to analyze patients with superficial bladder cancer who failed the initial therapy with oral BCG and underwent immunoprophylaxis with intravesical BCG. A total of 13 patients with grade 2 pT1 transitional cell carcinoma or carcinoma in situ without other concurrent malignancies had tumour recurrence with oral BCG therapy. We report our experience with 6 patients treated with intravesical BCG after failure of previous oral BCG immunotherapy. A quantitative deoxyribonucleic acid study using static cytometry was employed to analyze tumour ploidy. All were aneuploid tumours. 2 (33.3%) patients were free of cancer during the 21-month mean observation period and 4 (66.7%) had recurrence during a mean follow-up of 24 months. Two patients showed tumour progression. There were no major complications. Our results suggest that superficial transitional cell carcinoma of the bladder with aneuploid DNA values, even if treated more aggressively with intravesical BCG, do not show good results.

scholarly journals Systemic BCG-Osis as a Rare Side Effect of Intravesical BCG Treatment for Superficial Bladder Cancer

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
S. Lukacs ◽  
B. Tschobotko ◽  
N. A. Szabo ◽  
Andrew Symes
Keyword(s):  
Bladder Cancer ◽  
Respiratory Failure ◽  
Side Effect ◽  
Superficial Bladder Cancer ◽  
Transitional Cell ◽  
Bilevel Positive Airway Pressure ◽  
Bcg Therapy ◽  
Intravesical Bcg ◽  
Rare Side Effect ◽  
Intravesical Bcg Therapy

Intravesical Bacilli Calmette-Guérin (BCG) immunotherapy is a commonly used treatment for superficial bladder cancer. Although the treatment is well tolerated in 95% of cases, life-threatening side effects including BCG sepsis can occur. This report describes the case of an 82-year-old man with a background of lung disease. He developed septic shock and type two respiratory failure after receiving the sixth installation of intravesical BCG (TICE strain) immunotherapy for recurrent bladder Transitional Cell Carcinoma in situ. Despite the early initiation of broad spectrum antibiotics (tazocin and gentamicin), he remained pyrexial. There was a rapid deterioration, and on the second day of his admission, he developed type two respiratory failure secondary to Acute Respiratory Distress Syndrome (ARDS) prompting transfer to Intensive Care for Bilevel Positive Airway Pressure (BiPAP) Ventilation. The blood cultures taken before the induction of antibiotics results were negative. Increasing clinical suspicion of systemic BCG-osis prompted the initiation of antituberculosis therapy (ethambutol, isoniazid rifampicin) and steroids. Following six days of BiPAP and anti-tuberculosis therapy in ITU, his condition started to improve. Following a prolonged hospital stay he was discharged on long term ethambutol therapy. BCG-osis is a well-known though rare side effect of intravesical BCG therapy. We would like to highlight the importance of having a low threshold for starting anti-TB treatment.

scholarly journals A Rare Case of Sensory Neuropathy Associated with Transitional Cell Carcinoma of the Bladder

2020 ◽  
Vol 13 (3) ◽  
pp. 1397-1401
Author(s):  
Sujitha Ketineni ◽  
Sreenath Kodali ◽  
Sasikanth Gorantla
Keyword(s):  
Lymph Nodes ◽  
Transitional Cell Carcinoma ◽  
Cell Carcinoma ◽  
Rare Case ◽  
Transitional Cell ◽  
Sensory Neuropathy ◽  
Endobronchial Ultrasound ◽  
Whole Body ◽  
Initial Symptoms ◽  
Carcinoma Of The Bladder

Malignancies can trigger an autoimmune response against the nervous system and manifest as paraneoplastic neurological syndromes (PNS). Initial symptoms of PNS may develop up to 5 years prior to the diagnosis of the underlying malignancy. We report a rare case of PNS associated with transitional cell carcinoma of the bladder in a 70-year-old male with a 6-month history of rapidly progressive symmetric sensory neuropathy. Peripheral neuropathy serological workup was unremarkable. A paraneoplastic neuropathy panel revealed anti-Hu autoantibodies. Further evaluation with a whole-body PET scan could not identify the primary malignancy, but it showed hypermetabolic hilar lymph nodes. An endobronchial ultrasound biopsy of the hilar lymph nodes was negative for cancer. The patient developed painless hematuria 2.5 years after the onset of the sensory neuropathy. Cystoscopy with biopsy revealed non-muscle-invasive transitional cell carcinoma of the bladder. Progression of the sensory neuropathy stopped after tumor resection. This case highlights the importance of a diligent and systematic approach to diagnose PNS. A relentless search is often required to detect PNS-associated occult malignancies.

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