The use of BCG is best known as a vaccination against tuberculosis. However, its role in bladder cancer immunotherapy goes back almost four decades, and its success has prompted increasing interest in the manipulation of the immune system against tumours.
Some one-third of the world's population has latent tuberculosis (TB) infection, and prevention of transmission, contact tracing, screening and bacillus Calmette-Guérin (BCG) vaccination are key aspects of the global TB prevention programme. Routine BCG vaccination of all children as a prophylactic measure against TB was discontinued in the UK in 2005, but it is still used in countries where the condition is common, being given as a single intradermal dose as soon as possible after birth. In addition, adults who do not have tuberculosis and had not previously been immunised but are frequently exposed to tuberculosis may be offered immunisation.
Although generally widely recognised for its prophylactic role against TB, the immunological basis for its success in combating this widespread infectious disease is also utilised in the treatment of cancer, most notably early, non-invasive tumours of the bladder.
In this so-called intravesical therapy, a solution of BCG is introduced into the bladder once a week for six to nine weeks. The exact nature of the bladder’s response is unclear, but immunologically competent cells and cytokines appear to play a major role, as outlined later.
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