BCG and bladder cancer. Forty-eight years after Morales report.

IF 0.8 Q4 UROLOGY & NEPHROLOGY Urologia Journal Pub Date : 2024-08-01 Epub Date: 2024-05-17 DOI:10.1177/03915603241252909
Vincenzo Serretta
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Abstract

Although BCG use as an anticancer drug was nearly abandoned due to the poor results in most tumors, in 1976 Morales reported a relevant reduction in recurrence with intravesical BCG in few patients affected by NMIBC. Since then BCG was globally accepted as an empirical and effective therapy in treating Tis and preventing recurrence of intermediate and high risk NMIBC. Forty-eight years after Morales' report, although some open questions remain object of debate, we have been able to find answers to many doubts improving BCG activity and toxicity. We better select patients undergoing BCG and many trials have indicated the best dosage and schedule. Moreover, we are able to better identify the patient unresponsive to BCG who might benefit of a timely radical cystectomy. We are also aware of the difficulties and toxicities that can be encountered with BCG use in every-day clinical practice. Research is ongoing to obtain genetically modified BCG to increase its efficacy and reduce toxicity. Moreover, the combination of BCG with other immunotherapeutic drugs given intravesically or systemically, first immune checkpoint inhibitors, is under study to obtain a response in patients unresponsive or intolerant to BCG. Almost 50 years after Morales publication, intravesical BCG remains an inalienable tool against NMIBC.

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卡介苗与膀胱癌。莫拉莱斯报告发表 48 年后。
尽管卡介苗作为一种抗癌药物,由于对大多数肿瘤的治疗效果不佳而几乎被放弃,但 1976 年莫拉莱斯报告称,少数 NMIBC 患者膀胱内注射卡介苗后,复发率明显降低。从那时起,卡介苗就被全球公认为治疗蒂斯和预防中、高危 NMIBC 复发的经验性有效疗法。莫拉莱斯的报告发表 48 年后,尽管一些悬而未决的问题仍是争论的焦点,但我们已经找到了改善卡介苗活性和毒性的答案。我们更好地选择了接受卡介苗治疗的患者,许多试验也指出了最佳剂量和时间安排。此外,我们还能更好地识别对卡介苗无反应的患者,及时进行根治性膀胱切除术可能会使他们受益。我们也意识到在日常临床实践中使用卡介苗可能遇到的困难和毒性。目前正在研究如何获得转基因卡介苗,以提高其疗效并降低毒性。此外,卡介苗与其他经静脉或全身给药的免疫治疗药物(首先是免疫检查点抑制剂)的联合应用也在研究之中,目的是让对卡介苗无反应或不耐受的患者获得应答。在莫拉莱斯发表论文近 50 年后的今天,膀胱内卡介苗仍然是治疗非小细胞肺癌不可或缺的工具。
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来源期刊
Urologia Journal
Urologia Journal UROLOGY & NEPHROLOGY-
CiteScore
0.60
自引率
12.50%
发文量
66
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