CANCER. After confirming reflux with a cystogram, the lower ureters can be treated with intravesical BCG. Key Points • This involves having a catheter (plastic tube) passed into your bladder to instil an anti-cancer drug called BCG • BCG is a vaccine that is used against tuberculosis; it contains live BCG therapy: at all times throughout this procedure a closed system must be maintained and PPE must be worn; administer as per institutional policy; clamp (if patient unable to retain medication) or remove IDC; post instillation some clinicians recommend rotating position e.g. The most effective schedule would be BCG maintenance administered at months 3, 6, 12, 18, 24, 30, 36. Thereafter they leave the office and are asked to retain the suspension, if possible, for two hours. Excess BCG administration is associated with increased side effects and suppression of antitumor immune response. Women should avoid getting pregnant or breastfeeding while on BCG therapy. There is no need to repeat cystoscopy until at least 4-6 weeks after completion of the 6-week induction course. Herr HW, Pinsky CM, Willet FW, Sogani PC, Oettgen HF and Melamed MR: BCG reduces disease progression compared with surgery or surgery plus chemotherapy, and maintenance BCG results in a further significant reduction in progression. It then takes a period of time, as long as 6 months in some patients, for this immune response to destroy all remaining tumor cells. Wait three months and have cystoscope. instillations of 50ml 50% DMSO with 50ml Tice strain BCG (dose of BCG not reported, length of instillation not reported) given once a week for 6weeks in 75 people (71 women; mean age 59years) with painful bladder syndrome/interstitial cystitis. superficial bladder cancer. METHODS: To test the hypothesis that maintenance BCG immunotherapy might protect against the development of other malignancies as well as reduce bladder tumor recurrence, the incidence of other malignancies in patients enrolled in SWOG 8507 was recorded. Lamm DL, Morales A, Grossman HB, Lowe B, Swerdlow R, Ebert R, Habicht 156:1934-41,1996), but unfortunately chemotherapy does not reduce stage progression. Important: Avoid contact with BCG vaccin… Antitubercular antibiotics are infrequently necessary. 16620 N. 40th St. Suite E, Phoenix AZ 85032 Tice substrain . It's used to help keep the cancer from growing and to help keep it from coming back. Induction BCG followed by maintenance BCG instillation after TUR, compared with induction BCG along, can reduce the risk ratios of tumor recurrence and tumor progression, and prolong RFS. Below is the updated version of the BUI Bladder Instillations Protocol. Prepare solution: Add 1 mL sterile water for injection to 1 ampul of vaccine. Certaines des équipes qui utilisent la BCG thérapie d'entretien ont même changé de protocole au fil du temps. The 384 eligible patients who were disease-free at randomization constitute the primary intent to treat analytic group because they could be followed for disease recurrence. We have had a favorable experience with KLH (48% CR, Lamm,1996), and have an ongoing clinical trial. ҙB���Q�ya,0b��>�;&�E֧���M�|�>�a����������{�|�uׄ�u�u6!�ݧ\�����. I have patients lie on their abdomen for 15 minutes in the office to displace the anterior bubble that enters the bladder as the air is displaced from the catheter. 2. The preparation, called “Oncovite,” is made by Mission Pharmacal. Dr. Lamm reported that three-week maintenance therapy with BCG vaccine (Calmette-Guerin bacillus) in 385 subjects increased complete response in pre-invasive bladder cancer from 70 percent to 84 percent and reduced recurrence from 52 percent to 25 percent at eight years. In our animal model, prednisone alone increased mortality, but prednisone plus antibiotics markedly improved survival when compared with antibiotics alone. To decrease the chance of pyelovenous backflow, a manometer is used in a manner analogous to Renacidin irrigation. Each was determined by lab report stating 'malignant' or 'high grade bladder cancer'. Incidence and treatment, Lamm DL, Riggs D, Shriver J, VanGilder P, Rach J, DeHaven J: Megadose, Lamm DL, Morales A, Grossman HB, Lowe B, Swerdlow R, Ebert R, Habicht. Treatments are continued weekly to a total of 6 instillations. 13. Lamm DL, Meijden APM van der, Morales A, et al. For a print-friendly version of this material, click here. MAINTENANCE BCG IMMUNOTHERAPY: EVIDENCE OF ADDITIONAL PROTECTION AGAINST Overall, the recurrence rates for full-dose BCG, one-third dose BCG and one-third dose BCG plus interferon were 50%, 30% and 10% (Pearson’s test, p~O.O3S). Thanks to Crilly Butler for the above summary, back to non-muscle-invasive bladder cancer, Badalament RA, Herr HW, Wong GY, et al. 19:591-600,1992. Contraindications to BCG Intravesical Instillation (relative/absolute) • Absolute: – reaks in the urogenital epithelium: • Traumatic catheterisation (i.e. Intravesical BCG should not be given within one week of bladder tumor resection. The three week course of BCG is then repeated at 12, 18, 24, 30, and 36 months. Upper urinary tract involvement in patients with bladder carcinoma in The dose is two tablets twice a day (only three a day for persons under 100 lb). If symptoms are more severe or prolonged, isoniazid 300mg daily can be used to treat the symptoms. The local immune response is considered to be of primary importance in BCG immunotherapy, and up to 75% of men develop granuloma in the prostate following intravesical BCG. Bacillius Calmette-guerin is similar to the bacteria that causes tuberculosis. ABOUT BCG. Occasionally higher doses of prednisone are required. J Urol 147:4(242), 1992. Shellhammer reported 70% CR without TUR, but I prefer to resect the prostate to stage the disease and, hopefully, improve direct contact with BCG. N Engl J Med. Immune stimulation may reduce the risk of cancer associated with age-related waning of immunity. Intravesical Immnuotherapy uses a live vaccine called Bacillus Calmette-Guerin (BCG), which is also used to inoculate against Tuberculosis; when this is placed in the bladder it creates a local inflammatory reaction that kills cancer cells. 17. ABSTRACT. Never give BCG if symptoms from previous BCG administrations are still present, and never instill BCG if the catheterization is traumatic or bloody. At the three month evaluation, 192 in each arm were disease free and therefore eligible for evaluation of the benefit of maintenance BCG. Both are highly effective and safe, when used carefully. 20. It takes 6 weeks for the optimal immune response to develop in most patients when given the initial course of BCG. A single percutaneous treatment at the start of treatment should suffice. prone/ supine/ left lateral/ right lateral every 15 minutes for 1 hour Oncol. • Transfer appropriate amount of BCG directly into 50 cc vial of PBS/Intron A. interferon in carcinoma in situ of the bladder. The policy of withholding maintenance BCG from patients with increased side effects may have diminished the opportunity to observe severe toxicity. At each of these time points of BCG is instilled once a week for three weeks (i.e. %���� Draw into syringe and expel back into ampul 3 times to mix. The increased toxicity of maintenance BCG has been noted, but other benefits have been largely ignored. 147, 738-742, 1992. If symptoms respond within one week, isoniazid can be discontinued after the second or third week. Department of Urology - 1 - Disclaimer: This document contains information and/or instructional materials developed by Michigan Medicine for the typical patient with your condition. Discard syringe with vial venting device. This treatment is given to patients with non-muscle invasive bladder tumours. Lamm DL, Riggs D, Shriver J, VanGilder P, Rach J, DeHaven J: Megadose Single instillations have been demonstrated to be effective with Thiotepa, Adriamycin (50mg/50cc), Mitomycin (20mg/20cc), and Epirubicin, even in these “low risk” patients. After confirming reflux with a cystogram, intravesical BCG can then be used to treat the lower ureters. Of 251 men, 24% developed TCC of the prostatic urethra (median 11 months), and 44% or these relapses were fatal. BCG is not necessary unless tumor recurrence becomes a problem for these patients. J Urol. Wait three months and have cystoscope. That is why we always reduce the dose (1/3, 1/10, 1/100th even if needed) or hold treatment if increasing side effects are seen. 1. 139:300A (550), I therefore recommend the three week maintenance schedule (see below). Wait three months and have cystoscope. It is available over the counter, but generally has to be ordered by the pharmacy (800-531-3333). 14.4 Management options for side effects associated with intravesical BCG 57 14.5 EORTC Quality of Life questionnaires 59 14.6 Example of Competency document 62 14.7 Example of Training document 63 14.8 Examples of Documentation for MMC and BCG instillation 66 14.9 Example of Side effect questionnaire 68 Bacillus Calmette-Guerin or BCG is the most common intravesical immunotherapy for treating early-stage bladder cancer. Mitomycin C, on the other hand, inhibits the synthesis of DNA. While BCG has been compared to single agent intravesical chemotherapy as first-line therapy, few studies exist comparing BCG to sequential intravesical chemotherapy regimens. 5. therapy can also be very effective in BCG failures (Nseyo). Lamm DL, Sardosdy MF, Grau DA, Buchanan J, Hunt J, and DeHaven J: On May 5, 1999, Donald Lamm, MD, discussed a study recently completed by the Soutwest Oncology Group (SWOG) at the American Urological Association meeting in Dallas. Technique of BCG Maintenance. Based on previous reports, one would expect that 70% or more of patients treated with chemotherapy and 77% of patients treated with surgery alone would have had recurrence. /Creator (pdfFactory Pro www.fineprint.fr) Following the standard 6 week induction course of BCG, patients have cystoscopy at three months. The dose for the intravesical treatment of BCG is one vial suspended in 50 mL preservative free saline (0.9% Sodium Chloride Injection U.S.P). Maintenance BCG (once a week for 3 weeks) is begun at 3 months using 1/3 dose BCG, unless no side effects were noted during induction. For a print-friendly version of the following material, click here, A simplified summary of the protocol is also found below Though not statistically significant, in both our review and the EORTC/MRC meta analysis progression was actually higher in patients treated with chemotherapy than in controls. BCG immunotherapy can be more toxic than Mitomycin chemotherapy. After 28 years of academic practice, Dr. Lamm has opened a private practice limited to genito-urinary oncology: The dose amount expressed in milligrams varies according to the BCG substrain; the typical dose of BCG used for intravesical instillation is 1-8 x 10. Interferon has a 47% complete response rate in CIS, and we have seen long term responses and responses after BCG failure (Glashan). Nseyo, UO: Photodynamic Therapy. The medications work on the tumour cells on the inner lining of the bladder and help keep the cancer from coming back (recurrence). BCG instillation as per protocol Date instillation given Usual medications Assess for analgesia requirements 6 Diet & Hydration Usual diet and fluids Usual diet Encourage oral fluids after treatment 7 Hygiene Education provided on Chlorhex wash Pre procedure genital Chlorhex wash 8 Elimination & Safety Patient educated on safe voiding CONCLUSION: Stimulation of the immune system with 3-week maintenance BCG appears to reduce the incidence of subsequent malignancy, particularly carcinoma of the prostate. bladder cancer: a randomized prospective Southwest Oncology Group Lamm DL, Crawford ED, Blumenstein B, Crissman JD, Montie J, Gottesman J, Patients with a solitary papillary tumor that appears to be low grade can be best treated with single instillation of chemotherapy (Thiotepa 30mg/30cc water for 30 minutes, for example) at the conclusion of the resection. Percutaneous BCG may need to be repeated if the skin test is negative (less than 5mm of induration). Thus, strict adherence to the protocol for canceling the BCG in the presence of infection, and aborting the instillation in the setting of trauma and/or any degree of gross hematuria, is required. We now recommend supplemental vitamins for bladder cancer patients. After today's meeting w/ my Urologist, we talked about Tecentriq (just approved May 18, 2016) as replacement for BCG. The table on the next page shows the schedule of BCG … RESULTS: Seventy of the 35 randomized, evaluable patients developed Long-term effecto of intravesical Bacillus Calmette-Guerin on flat These patients can be safely treated in the office. The most commonly used agents are BCG (Bacillus Calmette-Guérin) and Mitomycin C. It is theorised that BCG stimulates an inflammatory response that promotes malignant cell kill by immunocompetent cells. Since cultures are often negative, treatment must be given empirically. Treatment protocols for bladder cancer are provided below, including those for chemotherapy, immunotherapy, and systemic neoadjuvant and adjuvant therapy. With sepsis the current treatment of choice is no longer cycloserine, but isoniazid, rifampin, and prednisone 40mg daily. *            *   *    *    *   *     *           *, * Bladder and prostatic urethra biopsy and ureteral wash for G3 or CIS, For a simple explanation of this protocol, see below Urology 49:347-352, 1997. Induction round of six weekly instillations. Depuis 35 ans, ce cancer, fréquent dans les pays industrialisés, est en partie traité par le BCG, le vaccin contre la tuberculose. If patients have moderate to severe side effects with the first or second of the three maintenance instillations, the remaining instillations in that course should be deleted. DeHaven JI, Traynellis CT, Riggs DR, and Lamm DL: Antibiotic and Steroid 1992;147:596. /CreationDate (D:20120911131858+02'00') At the next treatment interval (eg 6 months later), instillations should be initiated with log-lower BCG dose, 1/3, 1/10, or even 1/100th CFU BCG in 50cc preservative-free saline. In my comparison of 6 week induction BCG (Connaught) vs three-week maintenance, complete response was increased from 68% to 84%. This is an outpatient procedure during which a tube (catheter) is first inserted into the bladder, and a medication is infused through so that it can coat the inside of the bladder for a short time. Incidence and treatment Unused solution is discarded as biohazardous waste after 2 hours. 9. Herr HW, Pinsky CM, Willet FW, Sogani PC, Oettgen HF and Melamed MR: Hillyard RW Jr, Ladaga L, and Schellhammer PF, Superficial Transitional. BCG has been proven to be superior to chemotherapy (Thiotepa, Adriamycin, Mitomycin, and Epirubicin) in comparative controlled studies and BCG, but not chemotherapy, is found to significantly reduce disease progression. Long-term (5-8 year) recurrence is reduced by 7% (Pawinsky A , EORTC/MRC: J Urol. Lowe B, Sarosdy MF, Bohl RD, Weems WL, Grossman HB, Smith JA, Beck TM, The same dose of BCG is given in 50cc of saline and infused over 2 hours. The criteria for increased risk were 2 or more episodes of tumor within the most recent year, or 3 or more tumors within 6 months. /Producer (pdfFactory Pro 3.51 \(Windows XP Professional French\)) malignancy other that TCC during the 8 year follow-up: 46/202 (23%) in 8. 1/3 dose BCG weekly for up to 3 weeks beginning at 3 months (that would be 6 weeks after the 6 week induction). Purpose: Bacillus Calmette-Guerin (BCG) immunotherapy has been widely accepted as the optimal treatment for carcinoma in situ and high grade superficial transitional cell carcinoma. Caution must be taken to taper the prednisone slowly because hypotension may return when prednisone is stopped. Bladder Cancer, Genitourinary Oncology; BCG Oncology, P.C. This solution is placed into the bladder on a weekly basis and often monthly as a maintenance. >>stream Administer instillation into bladder via catheter (dwell time of 1-2 hours) *This is a single dose given in operating room or within 24 hours of transurethral bladder tumour resection. Maintenance therapy consisted of intravesical and percutaneous BCG each week for 3 weeks given 3, 6, 12, 18, 24, 30 and 36 months from initiation of induction therapy. 469 Background: Bacillus Calmette-Guerin (BCG) is the standard of care for patients with new non-muscle invasive bladder cancer (NMIBC) after transurethral tumor resection. {/niftybox} 157:4, (831), 1997 and when all randomized patients are included, mortality is also significantly reduced (Lamm, J Urol 143:341(610), 1990). However, controversy remains regarding the role of maintenance therapy, and its long-term effect on recurrence and progression. Maintenance BCG 1987;5:441. What is Bladder Instillation Therapy? An additional three weekly instillations can be given at three months, and followed with maintenance at 6 month intervals. Both of the Connaught BCG studies used percutaneous BCG. In patients with no disease or recurrence of disease without progression, three weekly instillations of BCG are given one week after cystoscopy. 9. In patients who have true BCG infection requiring antituberculous antibiotics, for example symptomatic prostatitis, epididymitis, or hepatitis, isoniazid plus rifampin 600mg daily should be given for 3-6 months. By lowering the dose of BCG to 1/3, 1/10/, 1/30, or 1/100th as needed to avoid increased irritative or systemic symptoms, very few patients have any difficulty with BCG immunotherapy. The prostatic urethra should be biopsied. 4 0 obj One drop of the BCG suspension to be given intravesically can be placed on the cleansed inner thigh and the skin punctured four times with a 28g needle (Tine technique). 3. Instillation of TICE BCG with an actively bleeding mucosa may promote systemic BCG infection. Lamm DL, Sardosdy MF, Grau DA, Buchanan J, Hunt J, and DeHaven J: Lamm DL, Blumenstein BA, Crawford ED, et al: A randomized trial of. update on the protocol: from Dr. Lamm’s site: It is also true that maintenance can cause side effects. Lamm est le premier à avoir suggéré un bénéfice de ce traitement. 1:119, 1995). J. Urol. 1988. The objective of this work … If symptoms do not respond or evidence of BCG infection other than local cystitis is present, we treat with isoniazid 300mg plus rifampin 600mg daily for three months (see below). Patients may be given Pyridium for dysuria, anticholinergics for frequency, and/or acetaminophen for pain. Only one of these five had advanced stage carcinoma of the prostate (Stage C) compared with six (43%, 3 stage C, 3 stage D) patients in the induction arm (RR 0.4, P=0.04). With serious infections triple antibiotic therapy may be needed, and ethambutol 1200mg daily or a fluoroquinolone may be added. For the latest published findings on maintenance therapy, see abstract below references. 14. Crisman, JE Montie, BA Lowe, MF Sarosdy, RD Bohl, HB Grossman, TM Beck, Photodynamic Hillyard RW Jr, Ladaga L, and Schellhammer PF, Superficial Transitional >> Introduction: Intravesical BCG immunotherapy and mitomycin C are considered as the standard treatment for non-muscle invasive bladder cancer. Patients with CIS or Grade 3 TCC are at long-term risk for tumor recurrence in the bladder, lower ureters, and prostatic urethra. If patients have no symptoms from BCG instillation, or if they have tumor recurrence, consider doing a PPD skin test. If irritative symptoms persist beyond three days, fail to respond to symptomatic treatment, or are severe isoniazid 300mg a day can be given. WARNING: Do not inject intravenously, subcutaneously, or intradermally. Progression was further significantly reduced(Lamm, J. Urol. Wait three months and have cystoscope. All patients were followed for adverse effects of treatment, recurrence, disease worsening and survival. Then follow at 4, 5 and 6 years, and then 8, 10 and 12 years. Do not use a filter with BCG instillation. 3 week maintenance is repeated at 6, 12, 18 and 24 months, and then at years 3, 4, 5 and 6 followed by … Wait three months and have cystoscope. All 4 CIS patients responded to combination therapy but 5 of 16 CIS patients treated with BCG alone did not. 4. TUR will also increase the contact of BCG with the prostatic urethra. Instillation Directions • Insert instillation spike with attached tubing and closed pinch clamp into top of PBS vial. Study. The global shortages in TICE BCG … Solsona et al reported TCC in the distal ureter in 25% of 138 patients with CIS treated with cystectomy compared with 2.3% of 786 patients with superficial bladder cancer and 2.9% of 179 patients with invasive disease (Solsona, 1997). With three additional BCG instillations at 3 months, the complete response per cent increased by 30% at 6 months. For patients with renal pelvic or upper ureteral TCC who are not candidates for nephroureterectomy, BCG can be given through a percutaneous nephrostomy tube. DL Lamm, BA Blumenstein, JD {niftybox width=180px,float=right,textalign=left}. 1. Solsona E, Iborra I, Rirus JV, Dumont R, Casanova JL, and Calabuig C: 1/3 dose BCG weekly for up to 3 weeks beginning at 3 months (that would be 6 weeks after the 6 week induction). I-II clinical trial. /Author (tbaril) Lamm DL, Crawford ED, Blumenstein B, Crissman JD, Montie J, Gottesman J, Lamm DL, Meijden APM van der, Morales A, et al. See package insert. Wait three months and have cystoscope. In patients with CIS treated with BCG, the incidence of TCC in the upper ureter is likely to be higher than the 25% reported by Herr in his combined series that included patients without CIS. The preparation of BCG suspension must be done using aseptic technique. 8. In my comparison TICE BCG using a monthly maintenance schedule with mitomycin C, 55% had complete response vs 44% CR with mitomycin (Urol. Solsona E, Iborra I, Rirus JV, Dumont R, Casanova JL, and Calabuig C: Divers protocoles d'entretien par le BCG ont été testés, mais aucun n'a été retenu comme protocole de référence. BCG is relatively resistant to cycloserine and pyrazinamide. CFU for the . Estimated median time for worsening-free survival, defined as no evidence of progression including pathological stage T2 disease or greater, or the use of cystectomy, systemic chemotherapy or radiation therapy, was 111.5 months in the no maintenance and not estimable in the maintenance arm (log rank p = 0.04). 6. Our double blind comparison of recommended daily allowance vitamins versus high doses of vitamins A, C, B6, E, and zinc (Lamm, 1994) in BCG treated patients demonstrated a remarkable and highly significant 40% further reduction in tumor recurrence. Simple explanation of Dr. Lamm’s protocol Current Recommendations for BCG Immunotherapy, Donald L. Lamm, MD. 2. the induction-only arm and 24/183 (13%) in the maintenance arm (relative risk 0.68, P=0.014). 1 0 obj %PDF-1.4 Then follow at 4, 5 and 6 years, and then 8, 10 and 12 years. BCG Bladder Instillation Instructions EXPLANATION: BCG is a solution made of the tubercular bacillus developed in such a way that it can be used in the treatment of bladder tumors. Recurrence of TCC in the prostatic urethra is common, and in patients with CIS or high grade TCC must be carefully sought. week 1 - 6 Induction BCG; week 12 Rigid cystoscopy after induction; week 14 - 16 Maintenance course 1; week 22 Flexible cystoscopy 1 OncoTICE BCG 12.5mg per vial containing 2-8 x 10 8 CFU Tice BCG.. After reconstitution in 50 ml saline the suspension contains 0.4-1.6 x 10 7 CFU/ml.. OncoTICE is a freeze-dried preparation containing attenuated bacilli of Mycobacterium bovis, prepared from a culture of Bacillus Calmette-Guérin (BCG). 10. Patients with CIS, Grade 3 TCC, or lamina propria invasion are best treated with BCG. In our SWOG study 660 patients received induction BCG and 550 were randomized to observation vs maintenance BCG. carcinoma in situ of the bladder. A prospective randomized trial, DeHaven JI, Traynellis CT, Riggs DR, and Lamm DL: Antibiotic and Steroid, Glashan RW: A randomized controlled study of intravesical alpha-2b. Swirl vial to mix completely. There are two different types of medications that can be used: 1. 3. Urol., bleeding) • Active infective cystitis • Persistent gross haematuria • Resection of bladder tumour within 2 weeks BCG is administered directly into the bladder via a catheter. BCG INSTILLATION . In patients with diffuse or aggressive disease, consideration should be given to resection of the ureteral orifices to induce reflux. I then do a second circumferential resection and send this specimen as “margin.” The results of BCG immunotherapy are excellent if there is no invasive TCC in the margin. A SOUTHWEST ONCOLOGY GROUP STUDY. Instillation of an immunotherapy drug (BCG) into the bladder for aggressive or frequently recurring non-muscle invasive cancer of the bladder. 8. Symptoms should last no more than 2 days. In my SWOG study of three week maintenance BCG, 14% of patients who had residual CIS at the three month evaluation went on to have complete response by the six month evaluation without further treatment. Treatment should be postponed for at least one week following transurethral resection, biopsy, 16. J Clin Oncol. The maintenance schedule also significantly reduced disease progression. Materials and Methods: All patients in the study had transitional cell carcinoma of the bladder with carcinoma in situ or an increased risk of recurrence. For less aggressive recurrent disease, the chemotherapy options remain. K: Keyhole-limpet hemocyanin (KLH) immunotherapy of papillary and in About two weeks after resection 81mg of Connaught BCG (TheraCys) or 50mg of TICE BCG in 50cc sterile normal saline can be instilled via a small catheter. Therefore, our next study will use percutaneous BCG. Patients require coverage for gram negative sepsis as well until blood cultures are negative. BCG must be used within 2 hours of reconstitution. /Filter/FlateDecode 21. The optimal dosage regimen for adjuvant therapy with intravesical BCG has not been established. Overall 5-year survival was 78% in the no maintenance compared to 83% in the maintenance arm. Use a condom between treatments and for six weeks following your final treatment. However, more than 90% of healthy adults will convert to a positive PPD skin test with percutaneous BCG, and a positive PPD increases the complete response in CIS from 49% to 77% (P<0.0001). Therefore, the most important time for evaluation in BCG treated patients is at 6 months. En 1985, cet auteur a rapporté qu'une instillation tous les 3 mois en plus du traiteme… 151:21-26, 1994. Conclusions: Compared to standard induction therapy maintenance BCG immunotherapy was beneficial in patients with carcinoma in situ and select patients with Ta, T1 bladder cancer. Common side effects of BCG include flu-like symptoms, fatigue, fever, chills, or bladder irritation. 11. If disease progression occurs, or grade 3 disease is present after 6 months of BCG treatment, cystectomy is generally recommended. Eighteen percent or more of patients will have complete response. BCG treatment for non-invasive bladder cancer BUI Protocol. Treatment of BCG Side Effects and Complications. Valstar (800 mg) has been recently approved for CIS patients who fail BCG and are not candidates for cystectomy. We expect to have mild to moderate irritative symptoms beginning after the second or third instillation. Wait three months and have cystoscope. H��W[sݶv~��[�3D\I��Ķ2�x�:�I_��H��Twi'n~}A�����3�hF6(`�׷��ȯ����_���w'��{�h+��we�tBS��M�;A{9��(�͉S.��k�qrָ���\�3����
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