IMMUNOTHERAPY OF BLADDER-CANCER

Intravesical therapy has been used in the management of superficial tr ansitional cell carcinoma (TCC) of the urinary bladder (i.e., Ta, T1, and carcinoma in situ) with specific objectives which include treating existing/residual tumor, preventing recurrence of tumor, preventing d isease progression, and prolonging survival, The initial clinical stag e and grade remain the main determinant factors in survival irrespecti ve of the treatment. Presently bacillus Calmette-Guerin (BCG) immunoth erapy remains the most effective treatment and prophylaxis for TCC (Ta , T1, CIS) and has positive outcomes on tumor recurrence rate, disease progression, and prolongation of survival. Prostatic urethral mucosal involvement with bladder cancer can be effectively treated with. BCG intravesical immunotherapy-it has demonstrated a reduction in tumor re currence rates, but has had no positive impact on disease progression or prolongation of survival. Interferons, keyhole-limpet hemocyanin (K LH), bropirimine, and PHOTOFRIN(R)-photodynamic therapy (PDT) are unde r investigation in the management of TCC and early results are encoura ging. This comprehensive review highlights recent developments in intr avesical therapy of bladder cancer and summarizes the mechanisms of ac tion of BCG, and the important role of intravesical BCG immunotherapy and other immunotherapeutic agents in the therapy and prophylaxis of s uperficial TCC-of the urinary bladder. (C) 1997 Wiley-Liss, Inc.