“Bacillus Calmette-Guérin (BCG) is the standard treatment option for non-muscleinvasive bladder cancer (NMIBC). The mechanism of BCG relies on live mycobacteria inducing an immune response in the bladder wall and is therefore commonly associated with inflammatory side effects and, rarely, mycobacterial infectious complications.

We studied the diagnostic options of erythematous bladder lesions encountered during follow-up of BCG-treated patients. We found that 90% of erythematous bladder lesions were benign manifestations of an inflammatory response to BCG. However, 23% of erythematous lesions showed malignancy in the presence of positive urinary cytology. Most unnecessary biopsies of erythematous lesions can be avoided with the use of urine cytology, and routine biopsy is not recommended. In the second part of the thesis, we identified patients who had developed a BCG infection following BCG therapy in Finland over a 20-year period using nationwide registers, and we described the incidence, mortality, and clinical presentation of BCG infections. These studies showed BCG therapy to be associated with a 1.9% cumulative risk of BCG infections presenting either as systemic or local genitourinary infections. Emphasising the severity, BCG infections were associated with an overall mortality of 10%. BCG infections may also develop more than a year after administration of BCG, demonstrating variability in their clinical manifestations. Finally, we compared BCG maintenance schedules with monthly instillations and the Southwest Oncology Group (SWOG) protocol in terms of tolerability and oncological efficacy. We found that monthly instillations may be considered a comparable option to the SWOG protocol in terms of tolerability and efficacy.

These studies describe the challenges in the follow-up of BCG-treated patients and highlight the risk of potentially severe adverse effects of BCG therapy, which should be recognised when initiating BCG. “

Här är en länk till dr Pertti Nurminen avhandling om BCG behandling och biverkningar:

Adverse Effects of Bacillus Calmette-Guérin (BCG) Therapy in the Treatment of Non-muscle-invasive Bladder Cancer (utupub.fi)