Slideshow
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Slide 1
Computed Tomography scan demonstrating bladder wall thickening consistent with urothelial carcinoma of the bladder
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Slide 2
Computed Tomography scan demonstrating bladder wall thickening consistent with urothelial carcinoma of the bladder
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Slide 3
Computed Tomography scan demonstrating bladder wall thickening consistent with urothelial carcinoma of the bladder
A 75-year-old man with significant coronary artery disease and renal insufficiency presented with painless gross hematuria and underwent a transurethral resection of bladder tumor (TURBT).
Pathology revealed high grade T1 urothelial carcinoma. Muscularis propria was present and uninvolved. He underwent a mandatory reresection of tumor base, which demonstrated no residual tumor. He elected to proceed with bacillus Calmette-Guerin (BCG) maintenance intravesical therapy.
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A recent prospective randomized trial from Europe demonstrated superiority of BCG Connaught over BCG Tice in preventing recurrence in non-muscle invasive bladder cancer patients.
The side effect profile was similar between the two strains. This finding correlated with more vigorous T-cell activation in a mouse model exposed to BCG Connaught.1
Currently, BCG Tice is the only available BCG strain in the U.S. Furthermore, the U.S. has recently experienced major shortages in the supply of this critical bladder cancer therapeutic.2
Answer: BCG Connaught strain appears to be more efficacious than BCG Tice
The case was prepared by Alexander Kutikov, MD, FACS, Associate Professor of Urologic Oncology, Fox Chase Cancer Center, Philadelphia.
References
- Rentsch CA, Birkhäuser FD, Biot C, et al. Bacillus Calmette-Guerin strain differences have an impact on clinical outcome in bladder cancer immunotherapy. Eur Urol 2014;66:677-688.
- Davies B. “Bladder cancer drug shortages and price gouging: The new reality.”
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