EFFECT OF KEYHOLE LIMPET HEMOCYANIN (KLH) AND BACILLUS-CALMETTE-GUERIN (BCG) INSTILLATION ON CARCINOMA IN-SITU OF THE URINARY-BLADDER

Patients with histologically verified carcinoma in situ (CIS) of the u rinary bladder (13 primary and 8 secondary CIS) were treated with intr avesical instillations of Keyhole Limper Hemocyanin (KLH) (20 mg KLH w eekly for 6 weeks, then monthly for 1 year or bimonthly for 2 subseque nt years. Patients, non-responding to 2 courses of KLH were then treat ed with regular Bacillus Calmette-Guerin instillations (120 mg BCG-Con naught strain). The follow-lip period ranged from 10 to 54 months (mea n 23.5 months). 7 patients (33%) were free of tumor after the first th erapeutical KLH course and 4 patients (19%) presented a complete-remis sion after the second KLH course (total primary response: 52%). 5 pati ents (24%) remained free of tumor during the established follow-rip pe riod (mean 31.7 months) and no evidence of further tumor progression o ccurred in patients after two courses of KLH treatment. However; 2 pat ients (9.5%) had to be cystectomized after KLH instillations because o f progressive disease of tumor recurrence. 8 patients (38%) had to rad ically cystectomized because of CIS persistence or progression after K LH and subsequent BCG treatment. Altogether 9 patients (42.8%) present ed long-term remissions, with a mean duration of 31.3 months. Instilla tions of KLH did not induce major side effects; however, instillations of BCG caused severe dysuria in 60% and fever in 40% of patients.