Urinary cytokines reflecting the immunological response in the urinary bladder to biological response modifiers: Their practical use

Background: Intravesical bacillus Calmette-Guerin (BCG) immunotherapy is cu rrently the most effective treatment for superficial transitional cell carc inoma (TCC) of the urinary bladder. In recent years, the substantial number of patients not responding to BCG or experiencing considerable toxicities has stimulated studies addressing either the development of improved BCG tr eatment schedules or the exploration of the therapeutic value of a series o f (novel) biological response modifiers, like interferons (IFNs), interleuk in (IL) 2 and keyhole limpet hemocyanin. Although the actual mechanism by w hich BCG exerts its antitumor effect still needs detailed unraveling, curre nt available knowledge suggests the induction of a T helper 1 (Th1) or Th1- like cytokine profile, represented by IL-2, IL-12 and IFN-gamma, as essenti al in the development of a cell mediated antitumor activity. Conclusions: i n this review, it is argued that incorporation of urinary cytokine determin ations, like IL-2 and possibly IL-12 and IFN-gamma, may represent a valuabl e approach in the optimization and individualization of the BCG therapy and an early, initial evaluation of the potential efficacy of novel immunomodu lating agents in the treatment of superficial TCC. Copyright (C) 2000 S. Ka rger AG, Basel.