Serial urinary IL-2, IL-6, IL-8, TNF alpha, UBC, CYFRA 21-1 and NMP22 during follow-up of patients with bladder cancer receiving intravesical BCG

Background: We evaluated the potential role of serial preinstillation level s of several interleukins, TNF alpha and urinary tumor markers to monitor p atients with bladder cancer receiving intravesical BCG. Patients and Method s: 121 urine samples were collected from: patients with bladder cancer trea ted with BCG (group 1); patients with bladder cancer receiving other intrav esical treatment (group 2) and patients with urinary tract infections (grou p 3). Cytokines [IL-2, IL6 and IL8] and TNF alpha and urinary tumor markers [UBC, CYFRA 21-1 and NMP22] were measured by immunoassays. Results: In 3 o ut of 15 BCG non-responders that recurred over the period of the study, no cytokine peak for IL-2, IL-6 or TNFa were detected. Urinary tumor markers i ncreased in 2 out of 3 of these patients earlier than scheduled cystoscopie s. Cytokine measurement was heterogeneous among 12 out of 15 BCG-responding patients: there were low levels of IL-6 and TNF a and peaks of IL-2 and IL -8 in 10 out of 12 and 4 out of 12 patients, respectively. During respondin g patients' followup we observed false-positive results in 7 out of 65 urin e samples for UBC, 8 out of 65 for CYFRA 21-1 and 20 out of 65 for NMP22. U rinary tract infections were the main factor associated with non-specific e levations of IL-6 and IL-8 and urinary tumor markers in all groups of patie nts. Conclusion: Although larger series are required to confirm our prelimi nary observations, our data argue for a potential predictive role for IL-2 of favourable response to BCG therapy. Monitoring BCG with urinary tumor ma rkers could early detect recurrence in non-responding patients.