This chapter provides a concise historical perspective and a comprehensive review of the place of BCG in the urological armamentarium. ?r. Lamm has highlighted the importance of basic research and its contribution in establishing the role of non-specific active immunotherapy for the treatment of cancer in humans. He has rightly emplasized that the frequently reported success of immunotherapy in experimental tumor systems has rarely been reproduced in their clinical counterparts. Part of the problem resides in the inherent behavioral differences between species but the disappointing clinical results, in many cases, can be traced to trial design in which the experience of basic investigators were largely ignored. In this context it is worth reiterating that the successful introduction of BCG as an effective anti-neoplastic agent in the particular situation of superficial vesical carcinoma was not fortuitous. It represents the clinical application of experimental studies carried out by a number of investigators not necessarily involved in the specific field of bladder cancer. Perhaps the most relevant, early work was that of Coe and Feldman  who elegantly demonstrated that the bladder is an ideal and unique organ for the extracutaneous induction of delayed hypersensitivity reactions. A second, important piece of information resulted from a series of well-constructed experiments aimed at establishing the effectiveness of non-specific active immunotherapy in a well defined animal model (reference 9 in the chapter). These experiments provided the cornerstone for the design of clinical protocols employing immune modulators. With this information available, it was apparent that superficial bladder cancer is an ideal candidate for regional BCG therapy: According to Coe and Feldman the bladder would exhibit a strong cellular-mediated response to antigenic stimuli and the human organ-tumor system would completely fulfill the postulates for successful therapy enunciated by Zbar and his group.
KeywordsBladder Cancer Important Piece Unique Organ Successful Introduction Superficial Bladder Cancer
- 2.Nickel JC, Morales A, Heaton JP, Costerton JW: Ultrastructural study of the interaction of BCG with bladder mucosa after intravesical treatment of bladder cancer. J Urol 133: 26A, 1985Google Scholar