TY - JOUR
T1 - Bacillus Calmette-Guerin immunotherapy for bladder cancer: a review of immunological aspects, clinical effects and BCG infections
T2 - A review of immunological aspects, clinical effects and BCG infections
AU - Larsen, Emilie Stavnsbjerg
AU - Joensen, Ulla Nordström
AU - Poulsen, Alicia Martin
AU - Goletti, Delia
AU - Johansen, Isik Somuncu
N1 - © 2019 APMIS. Published by John Wiley & Sons Ltd.
PY - 2020/2
Y1 - 2020/2
N2 - Bacillus Calmette–Guérin (BCG) immunotherapy for bladder cancer has been used since 1976 when the first evidence of its ability to lower recurrence and progression rates was published. Today, BCG immunotherapy is the choice of care for high-grade non-muscle invasive bladder cancer (NMIBC) after transurethral resection. This article presents indications and procedure of BCG instillations, and outlines the effects on recurrence and progression of NMIBC. The BCG-induced immunity in NMIBC is not yet fully understood. Animal studies point towards BCG inducing specific tumour immunity. We describe the current knowledge of how this immunity is induced, from internalization of BCG bacilli in urothelial cells, to cytokine- and chemokine-mediated recruitment of neutrophils, monocytes, macrophages, T cells, B cells and natural killer cells. In addition, we describe the process of trained immunity, the non-specific protective effects of BCG. Recent studies also indicate that dysbiosis of the urinary microbiome may cause lower urinary tract dysfunction. Side effects of BCG bladder instillations range from common, mild and transient symptoms, such as dysuria and flu-like symptoms, to more severe and rarely occurring life-threatening complications. We review the literature and give an overview of reported incidences and management of BCG infections after intravesical instillation.
AB - Bacillus Calmette–Guérin (BCG) immunotherapy for bladder cancer has been used since 1976 when the first evidence of its ability to lower recurrence and progression rates was published. Today, BCG immunotherapy is the choice of care for high-grade non-muscle invasive bladder cancer (NMIBC) after transurethral resection. This article presents indications and procedure of BCG instillations, and outlines the effects on recurrence and progression of NMIBC. The BCG-induced immunity in NMIBC is not yet fully understood. Animal studies point towards BCG inducing specific tumour immunity. We describe the current knowledge of how this immunity is induced, from internalization of BCG bacilli in urothelial cells, to cytokine- and chemokine-mediated recruitment of neutrophils, monocytes, macrophages, T cells, B cells and natural killer cells. In addition, we describe the process of trained immunity, the non-specific protective effects of BCG. Recent studies also indicate that dysbiosis of the urinary microbiome may cause lower urinary tract dysfunction. Side effects of BCG bladder instillations range from common, mild and transient symptoms, such as dysuria and flu-like symptoms, to more severe and rarely occurring life-threatening complications. We review the literature and give an overview of reported incidences and management of BCG infections after intravesical instillation.
KW - BCG
KW - BCG infection
KW - bladder cancer
KW - immunotherapy
KW - intravesical instillation
UR - http://www.scopus.com/inward/record.url?scp=85078666141&partnerID=8YFLogxK
U2 - 10.1111/apm.13011
DO - 10.1111/apm.13011
M3 - Review
C2 - 31755155
SN - 0903-4641
VL - 128
SP - 92
EP - 103
JO - APMIS - Journal of Pathology, Microbiology and Immunology
JF - APMIS - Journal of Pathology, Microbiology and Immunology
IS - 2
ER -