In our animal model, prednisone alone increased mortality, but prednisone plus antibiotics markedly improved survival when compared with antibiotics alone. Of 251 men, 24% developed TCC of the prostatic urethra (median 11 months), and 44% or these relapses were fatal. 17. If all clear, wait a week and begin third maintenance round of 3 weekly instillations (Month 12, or Year 1) situ transitional cell carcinoma of the bladder: a multicenter phase I have patients lie on their abdomen for 15 minutes in the office to displace the anterior bubble that enters the bladder as the air is displaced from the catheter. Instillation of TICE BCG with an actively bleeding mucosa may promote systemic BCG infection. Below is the updated version of the BUI Bladder Instillations Protocol. By lowering the dose of BCG to 1/3, 1/10/, 1/30, or 1/100th as needed to avoid increased irritative or systemic symptoms, very few patients have any difficulty with BCG immunotherapy. 1988. At least 1 week following biopsy of carcinoma in situ and resection of any stage Ta or T1 transitional cell tumors 660 patients were started on a 6-week induction course of intravesical and percutaneous Connaught BCG. 19:591-600,1992. A prospective randomized trial Patients with CIS or Grade 3 TCC are at long-term risk for tumor recurrence in the bladder, lower ureters, and prostatic urethra. Each was determined by lab report stating 'malignant' or 'high grade bladder cancer'. Solsona et al reported TCC in the distal ureter in 25% of 138 patients with CIS treated with cystectomy compared with 2.3% of 786 patients with superficial bladder cancer and 2.9% of 179 patients with invasive disease (Solsona, 1997). With three additional BCG instillations at 3 months, the complete response per cent increased by 30% at 6 months. Important: Avoid contact with BCG vaccin… Intravesical Immnuotherapy uses a live vaccine called Bacillus Calmette-Guerin (BCG), which is also used to inoculate against Tuberculosis; when this is placed in the bladder it creates a local inflammatory reaction that kills cancer cells. BCG (Bacillus Calmette-Guérin) is a type of immunotherapy used in the treatment of bladder cancer. Follow with 3 weekly instillations (reduced dose as needed) at 6, 12, 18, 24 and 36 month. If all clear, wait a week and begin sixth maintenance round of 3 weekly instillations (Month 30) OncoTICE BCG 12.5mg per vial containing 2-8 x 10 8 CFU Tice BCG.. After reconstitution in 50 ml saline the suspension contains 0.4-1.6 x 10 7 CFU/ml.. OncoTICE is a freeze-dried preparation containing attenuated bacilli of Mycobacterium bovis, prepared from a culture of Bacillus Calmette-Guérin (BCG). ____________________________________________________, MAINTENANCE BACILLUS CALMETTE-GUERIN IMMUNOTHERAPY FOR RECURRENT TA, T1 AND CARCINOMA IN SITU TRANSITIONAL CELL CARCINOMA OF THE BLADDER: A RANDOMIZED SOUTHWEST ONCOLOGY GROUP STUDY, DONALD L. LAMM*†; BRENT A. BLUMENSTEIN; JOHN D. CRISSMAN; JAMES E. MONTIE; JAMES E. GOTTESMAN; BRUCE A. LOWE; MICHAEL F. SAROSDY‡; ROBERT D. BOHL; H. BARTON GROSSMAN§; THOMAS M. BECK; JOSEPH T. LEIMERT; E. DAVID CRAWFORD||, From the West Virginia University Medical Center, Morgantown, West Virginia, Southwest Oncology Group Statistical Center and Swedish Hospital Tumor Institute, Seattle, Washington, Harper Hospital, Detroit and University of Michigan Medical Center, Ann Arbor, Michigan, Oregon Health Sciences University and Northwest Clinical Oncology Program, Portland, Oregon, University of Texas Health Science Center at San Antonio, San Antonio and University of Texas M. D. Anderson Cancer Center, Houston, Texas, Columbus Clinical Oncology Program, Columbus, Ohio, St. Luke’s Regional Medical Center, Boise, Idaho, and University of Colorado, Denver, Colorado THE JOURNAL OF UROLOGY 2000;163:1124-1129 Online at http://www.jurology.com April 2000, p. 1124 bladder cancer: a randomized prospective Southwest Oncology Group Les premières évaluations de la BCG thérapie d'entretien datent du milieu des années 1980. I have had 3 treatment periods of BCG's. The maintenance schedule also significantly reduced disease progression. 8. Common side effects of BCG include flu-like symptoms, fatigue, fever, chills, or bladder irritation. x En 1985, cet auteur a rapporté qu'une instillation tous les 3 mois en plus du traiteme… It takes 6 weeks for the optimal immune response to develop in most patients when given the initial course of BCG. Technique of BCG Maintenance. Recurring use of BCG increases the likelihood of more severe side effects like greater bladder irritation and inflammation and a burning feeling in the bladder and … Administer instillation into bladder via catheter (dwell time of 1-2 hours) *This is a single dose given in operating room or within 24 hours of transurethral bladder tumour resection. /CreationDate (D:20120911131858+02'00') In my comparison of 6 week induction BCG (Connaught) vs three-week maintenance, complete response was increased from 68% to 84%. This treatment is given to patients with non-muscle invasive bladder tumours. BCG sepsis can be fatal, and prompt and effective treatment is necessary. 4. The most effective schedule would be BCG maintenance administered at months 3, 6, 12, 18, 24, 30, 36. >> 18. Therefore, I recommend annual cystoscopic examination under anesthesia, with upper tract washes and retrogrades (followed by ureteroscopy if the retrograde shows anything) in these patients. 12. The 384 eligible patients who were disease-free at randomization constitute the primary intent to treat analytic group because they could be followed for disease recurrence. 2. Treatment protocols for bladder cancer are provided below, including those for chemotherapy, immunotherapy, and systemic neoadjuvant and adjuvant therapy. However, controversy remains regarding the role of maintenance therapy, and its long-term effect on recurrence and progression. Hillyard RW Jr, Ladaga L, and Schellhammer PF, Superficial Transitional Draw into syringe and expel back into ampul 3 times to mix. Nothing is lost by postponing BCG treatment if patients have symptoms, because symptoms are evidence of continued immune stimulation. The medications work on the tumour cells on the inner lining of the bladder and help keep the cancer from coming back (recurrence). To decrease the chance of pyelovenous backflow, a manometer is used in a manner analogous to Renacidin irrigation. Depuis 35 ans, ce cancer, fréquent dans les pays industrialisés, est en partie traité par le BCG, le vaccin contre la tuberculose. In patients with CIS treated with BCG, the incidence of TCC in the upper ureter is likely to be higher than the 25% reported by Herr in his combined series that included patients without CIS. That is why we always reduce the dose (1/3, 1/10, 1/100th even if needed) or hold treatment if increasing side effects are seen. These guidelines aim to describe the optimal condition to perform intravesical instillation of BCG or mitomycin C in order to increase its oncologic efficiency and to decrease its morbidity. BCG is relatively resistant to cycloserine and pyrazinamide. Symptoms should last no more than 2 days. Use a condom between treatments and for six weeks following your final treatment. Patients require coverage for gram negative sepsis as well until blood cultures are negative. 16620 N. 40th St. Suite E, Phoenix AZ 85032 Median recurrence-free survival time was twice as long in the 3-week maintenance arm compared to the no maintenance arm, and patients had significantly longer worsening-free survival. BCG maintenance therapy also reduced the incidence of other cancers, primarily prostate cancer. For a print-friendly version of this material, click here. The most commonly used agents are BCG (Bacillus Calmette-Guérin) and Mitomycin C. It is theorised that BCG stimulates an inflammatory response that promotes malignant cell kill by immunocompetent cells. Wait three months and have cystoscope. Consideration should also be given to transurethral resection of the prostate in these patients to reduce the risk of occult TCC in the prostatic ducts progressing to invasive disease. Since cultures are often negative, treatment must be given empirically. Key Points • This involves having a catheter (plastic tube) passed into your bladder to instil an anti-cancer drug called BCG • BCG is a vaccine that is used against tuberculosis; it contains live Wait three months and have cystoscope. *            *   *    *    *   *     *           *, * Bladder and prostatic urethra biopsy and ureteral wash for G3 or CIS, For a simple explanation of this protocol, see below Treatment involves placing a … Randomized prospective comparison of intravesical Tice BCG immunotherapy Incidence and treatment TURBT      Cysto  x  x    x   x   x    x           x  x  x  x  x 19. Lowe B, Sarosdy MF, Bohl RD, Weems WL, Grossman HB, Smith JA, Beck TM, Avoid exposing BCG to direct sunlight. Wait three months and have cystoscope. Wait three months and have cystoscope. Estimated median recurrence-free survival was 35.7 months (95% confidence interval 25.1 to 56.8) in the no maintenance and 76.8 months (64.3 to 93.2) in the maintenance arm (log rank p <0.0001). BCG instillation as per protocol Date instillation given Usual medications Assess for analgesia requirements 6 Diet & Hydration Usual diet and fluids Usual diet Encourage oral fluids after treatment 7 Hygiene Education provided on Chlorhex wash Pre procedure genital Chlorhex wash 8 Elimination & Safety Patient educated on safe voiding 21. CANCER. Wait three months and have cystoscope. 156:1934-41,1996), but unfortunately chemotherapy does not reduce stage progression. with and without percutaneous administration. Bladder Cancer, Genitourinary Oncology; BCG Oncology, P.C. We expect to have mild to moderate irritative symptoms beginning after the second or third instillation. Dr. Lamm reported that three-week maintenance therapy with BCG vaccine (Calmette-Guerin bacillus) in 385 subjects increased complete response in pre-invasive bladder cancer from 70 percent to 84 percent and reduced recurrence from 52 percent to 25 percent at eight years. The local immune response is considered to be of primary importance in BCG immunotherapy, and up to 75% of men develop granuloma in the prostate following intravesical BCG. A prospective randomized trial, DeHaven JI, Traynellis CT, Riggs DR, and Lamm DL: Antibiotic and Steroid, Glashan RW: A randomized controlled study of intravesical alpha-2b. H��W[sݶv~��[�3D\I��Ķ2�x�:�I_��H��Twi'n~}A�����3�hF6(`�׷��ȯ����_���w'��{�h+��we�tBS��M�;A{9��(�͉S.��k�qrָ���\�3���� If all clear, wait a week and begin fourth maintenance round of 3 weekly instillations (Month 18) (Month 0) The preparation we now use has been modified (improved, we hope) from our original study based on subsequent research. The policy of withholding maintenance BCG from patients with increased side effects may have diminished the opportunity to observe severe toxicity. The dose is two tablets twice a day (only three a day for persons under 100 lb). Urol., Bacillus Calmette-Guerin or BCG is the most common intravesical immunotherapy for treating early-stage bladder cancer. 469 Background: Bacillus Calmette-Guerin (BCG) is the standard of care for patients with new non-muscle invasive bladder cancer (NMIBC) after transurethral tumor resection. /Title (5 - Instillation BCG.pub) This solution is placed into the bladder on a weekly basis and often monthly as a maintenance. METHODS: To test the hypothesis that maintenance BCG immunotherapy might protect against the development of other malignancies as well as reduce bladder tumor recurrence, the incidence of other malignancies in patients enrolled in SWOG 8507 was recorded. 155:622A(1405), 1996. It is available over the counter, but generally has to be ordered by the pharmacy (800-531-3333). Previous randomized controlled trials have shown no advantage to maintenance BCG, but my maintenance schedule using 3 weekly treatments has been found to be dramatically superior. Induction round of six weekly instillations. Vol. The prostatic urethra should be biopsied. In case of BCG shortage: i. BCG is not necessary unless tumor recurrence becomes a problem for these patients. Conclusions: Compared to standard induction therapy maintenance BCG immunotherapy was beneficial in patients with carcinoma in situ and select patients with Ta, T1 bladder cancer. 14. /Creator (pdfFactory Pro www.fineprint.fr) The global shortages in TICE BCG … Lamm DL, Sardosdy MF, Grau DA, Buchanan J, Hunt J, and DeHaven J: In my comparison TICE BCG using a monthly maintenance schedule with mitomycin C, 55% had complete response vs 44% CR with mitomycin (Urol. In my SWOG study of three week maintenance BCG, 14% of patients who had residual CIS at the three month evaluation went on to have complete response by the six month evaluation without further treatment. If patients have no symptoms from BCG instillation, or if they have tumor recurrence, consider doing a PPD skin test. I begin with a superficial, circumferential resection of the prostatic urethra. Le BCG : un traitement efficace dans le cancer de la vessie Limiter les rechutes dans le cancer de la vessie, voici l'enjeu d'une étude dirigée par l'équipe de Matthew Albert à l'Institut Pasteur. For patients with renal pelvic or upper ureteral TCC who are not candidates for nephroureterectomy, BCG can be given through a percutaneous nephrostomy tube. Crisman, JE Montie, BA Lowe, MF Sarosdy, RD Bohl, HB Grossman, TM Beck, 14.4 Management options for side effects associated with intravesical BCG 57 14.5 EORTC Quality of Life questionnaires 59 14.6 Example of Competency document 62 14.7 Example of Training document 63 14.8 Examples of Documentation for MMC and BCG instillation 66 14.9 Example of Side effect questionnaire 68 1. bleeding) • Active infective cystitis • Persistent gross haematuria • Resection of bladder tumour within 2 weeks BCG is a germ that's related to the one that causes tuberculosis (TB), but it doesn’t usually cause serious disease. of maintenance versus nonmaintenance intravesical Bacillus << Glashan RW: A randomized controlled study of intravesical alpha-2b Notably, the reduction in the incidence of prostate cancer was greater than the reduction in other malignancies: 14 of 179 men (6.9%) in the induction arm versus 5 of 151 (3.3%) in the maintenance arm. All patients were followed for adverse effects of treatment, recurrence, disease worsening and survival. Wait three months and have cystoscope. CFU for the . Prepare solution: Add 1 mL sterile water for injection to 1 ampul of vaccine. ABOUT BCG. Instruct to keep vaccination site dry for 24 h; no dressing is needed. If disease progression occurs, or grade 3 disease is present after 6 months of BCG treatment, cystectomy is generally recommended. Patients with a solitary papillary tumor that appears to be low grade can be best treated with single instillation of chemotherapy (Thiotepa 30mg/30cc water for 30 minutes, for example) at the conclusion of the resection. Side effects of intravesical therapies. 1. The same dose of BCG is given in 50cc of saline and infused over 2 hours. Solsona E, Iborra I, Rirus JV, Dumont R, Casanova JL, and Calabuig C: 1/3 dose BCG weekly for up to 3 weeks beginning at 3 months (that would be 6 weeks after the 6 week induction). In patients with no disease or recurrence of disease without progression, three weekly instillations of BCG are given one week after cystoscopy. Cell Carcinoma of the Bladder Associated With Mucosa Involvement of the Photodynamic 10. Thereafter they leave the office and are asked to retain the suspension, if possible, for two hours. << Mitomycin C, on the other hand, inhibits the synthesis of DNA. While BCG has been compared to single agent intravesical chemotherapy as first-line therapy, few studies exist comparing BCG to sequential intravesical chemotherapy regimens. tel: 602 493 6626. However, more than 90% of healthy adults will convert to a positive PPD skin test with percutaneous BCG, and a positive PPD increases the complete response in CIS from 49% to 77% (P<0.0001). Caution must be taken to taper the prednisone slowly because hypotension may return when prednisone is stopped. MAINTENANCE BCG IMMUNOTHERAPY: EVIDENCE OF ADDITIONAL PROTECTION AGAINST We have had a favorable experience with KLH (48% CR, Lamm,1996), and have an ongoing clinical trial. 3. The preparation of BCG suspension must be done using aseptic technique. After 28 years of academic practice, Dr. Lamm has opened a private practice limited to genito-urinary oncology: With serious infections triple antibiotic therapy may be needed, and ethambutol 1200mg daily or a fluoroquinolone may be added. Divers protocoles d'entretien par le BCG ont été testés, mais aucun n'a été retenu comme protocole de référence. With sepsis the current treatment of choice is no longer cycloserine, but isoniazid, rifampin, and prednisone 40mg daily. See package insert. For the latest published findings on maintenance therapy, see abstract below references. Therapy of Massive Bacillus Calmette-Guerin (BCG) Toxicity, J. Contraindications to BCG Intravesical Instillation (relative/absolute) • Absolute: – reaks in the urogenital epithelium: • Traumatic catheterisation (i.e. If irritative symptoms persist beyond three days, fail to respond to symptomatic treatment, or are severe isoniazid 300mg a day can be given. 2. Results: No toxicities above grade 3 were noted in the 243 maintenance arm patients. or 10.5+/- … The optimal dosage regimen for adjuvant therapy with intravesical BCG has not been established. 1:119, 1995). In patients with CIS, Grade 3, or stage T1 disease I therefore recommend continuation of three week maintenance at years 4, 5, 6, 8, 10, and 12. Instillation Directions • Insert instillation spike with attached tubing and closed pinch clamp into top of PBS vial. We would like to show you a description here but the site won’t allow us. Instillation of an immunotherapy drug (BCG) into the bladder for aggressive or frequently recurring non-muscle invasive cancer of the bladder. Wait three months and have cystoscope. I then do a second circumferential resection and send this specimen as “margin.” The results of BCG immunotherapy are excellent if there is no invasive TCC in the margin. BCG reduces disease progression compared with surgery or surgery plus chemotherapy, and maintenance BCG results in a further significant reduction in progression. Badalament RA, Herr HW, Wong GY, et al. BCG treatment for non-invasive bladder cancer BUI Protocol. Antitubercular antibiotics are infrequently necessary. Only one of these five had advanced stage carcinoma of the prostate (Stage C) compared with six (43%, 3 stage C, 3 stage D) patients in the induction arm (RR 0.4, P=0.04). Following the six month cystoscopy, an additional three weekly instillations are given. Wait three months and have cystoscope. If all clear, wait a week and begin fifth maintenance round of 3 weekly instillations (Month 24, or Year 2) K: Keyhole-limpet hemocyanin (KLH) immunotherapy of papillary and in intravesical doxorubicin and immunotherapy with Bacille Calmette-Guérin instillations of 50ml 50% DMSO with 50ml Tice strain BCG (dose of BCG not reported, length of instillation not reported) given once a week for 6weeks in 75 people (71 women; mean age 59years) with painful bladder syndrome/interstitial cystitis. BCG INSTILLATION . ABSTRACT. Certaines des équipes qui utilisent la BCG thérapie d'entretien ont même changé de protocole au fil du temps. In Herr’s experience with BCG treatment without maintenance therapy, 69% had tumor recurrence or progression by ten years (JCO. 3 week maintenance is repeated at 6, 12, 18 and 24 months, and then at years 3, 4, 5 and 6 followed by … J. Urol. 1991;325:1205. All 4 CIS patients responded to combination therapy but 5 of 16 CIS patients treated with BCG alone did not. At each of these time points of BCG is instilled once a week for three weeks (i.e. {/niftybox} Although systemic infections involving non-GU organs are uncommon, these infections are associated with significant morbidity, and mortality. After today's meeting w/ my Urologist, we talked about Tecentriq (just approved May 18, 2016) as replacement for BCG. For less aggressive recurrent disease, the chemotherapy options remain. Prostatic Urethra: Results of Treatment With Intravesical Bacillus Intravesical BCG should not be given within one week of bladder tumor resection. /Filter/FlateDecode • Transfer appropriate amount of BCG directly into 50 cc vial of PBS/Intron A. Though a major component of this reaction is hypersensitivity, prednisone alone without isoniazid and rifampin should not be given. I therefore recommend the three week maintenance schedule (see below). An additional three weekly instillations can be given at three months, and followed with maintenance at 6 month intervals. Shellhammer reported 70% CR without TUR, but I prefer to resect the prostate to stage the disease and, hopefully, improve direct contact with BCG. Calmette-Guérin; J. Urol. vitamins in bladder cancer: A double-blind clinical trial. J Urol Induction BCG followed by maintenance BCG instillation after TUR, compared with induction BCG along, can reduce the risk ratios of tumor recurrence and tumor progression, and prolong RFS. Eighteen percent or more of patients will have complete response. 157:4, (831), 1997 and when all randomized patients are included, mortality is also significantly reduced (Lamm, J Urol 143:341(610), 1990). Alternatively, BCG can be given via ureteral catheters or intravesically, if reflux to the tumor site is confirmed. �LJ*W~� ��j��C;L�u=W���|���[�����p��T[��Iy{�6��L[�[�? Lamm DL, Blumenstein BA, Crawford ED, et al: A randomized trial of �w:k>4����׬��J�Y����4ϧY�;{��y��$9]NO�����������E#��Fx+)3�7&F�RF��y�ÿ��_��2Ƅ�����5��v��a������} r���{7�`tછ�~;KeL�s���0=���y���!N�ƾ#1���98mo��7iu��&��ˑw��ӗ��}����K�q�����]F Can be reconstituted via syringe method or using closed system administration supplies. Department of Urology - 1 - Disclaimer: This document contains information and/or instructional materials developed by Michigan Medicine for the typical patient with your condition. Therefore, the most important time for evaluation in BCG treated patients is at 6 months. 151:21-26, 1994. Our double blind comparison of recommended daily allowance vitamins versus high doses of vitamins A, C, B6, E, and zinc (Lamm, 1994) in BCG treated patients demonstrated a remarkable and highly significant 40% further reduction in tumor recurrence. Lamm DL, Crawford ED, Blumenstein B, Crissman JD, Montie J, Gottesman J, Lamm DL, Meijden APM van der, Morales A, et al. 7. 6. Single instillations have been demonstrated to be effective with Thiotepa, Adriamycin (50mg/50cc), Mitomycin (20mg/20cc), and Epirubicin, even in these “low risk” patients. >>stream If symptoms respond within one week, isoniazid can be discontinued after the second or third week. J Urol 147:4(242), 1992. My randomized comparison of intravesical with or without percutaneous TICE BCG administration (J Urol 145:738, 1991) showed no added benefit of percutaneous BCG. Lamm DL, Meijden APM van der, Morales A, et al. J Urol. 8. 3. Women should avoid getting pregnant or breastfeeding while on BCG therapy. CIS of the lower ureters can be managed by resection of the anterior wall of the intramural ureter over an indwelling stent to induce reflux. BCG has been proven to be superior to chemotherapy (Thiotepa, Adriamycin, Mitomycin, and Epirubicin) in comparative controlled studies and BCG, but not chemotherapy, is found to significantly reduce disease progression. Maintenance BCG (once a week for 3 weeks) is begun at 3 months using 1/3 dose BCG, unless no side effects were noted during induction. Based on previous reports, one would expect that 70% or more of patients treated with chemotherapy and 77% of patients treated with surgery alone would have had recurrence. One drop of the BCG suspension to be given intravesically can be placed on the cleansed inner thigh and the skin punctured four times with a 28g needle (Tine technique). Wait three months and have cystoscope. DL Lamm, BA Blumenstein, JD Swirl vial to mix completely. 13. 11. Wait three months and have cystoscope. If patients have moderate to severe side effects with the first or second of the three maintenance instillations, the remaining instillations in that course should be deleted. In our SWOG study 660 patients received induction BCG and 550 were randomized to observation vs maintenance BCG. After confirming reflux with a cystogram, the lower ureters can be treated with intravesical BCG. Most of these patients will have had an induction course of BCG, so three rather than six instillations would be appropriate. Long-term effecto of intravesical Bacillus Calmette-Guerin on flat 1992;147:596. Therefore, our next study will use percutaneous BCG. Urol Clin N Amer. Then follow at 4, 5 and 6 years, and then 8, 10 and 12 years. Week 2 Month 3   6  12  18  24  30 Year  3  4  5  6  8  10  12 Immune stimulation may reduce the risk of cancer associated with age-related waning of immunity. A SOUTHWEST ONCOLOGY GROUP STUDY. 6. Treatment of BCG Side Effects and Complications. Herr HW, Pinsky CM, Willet FW, Sogani PC, Oettgen HF and Melamed MR: Hillyard RW Jr, Ladaga L, and Schellhammer PF, Superficial Transitional. endobj Estimated median time for worsening-free survival, defined as no evidence of progression including pathological stage T2 disease or greater, or the use of cystectomy, systemic chemotherapy or radiation therapy, was 111.5 months in the no maintenance and not estimable in the maintenance arm (log rank p = 0.04). Intravesical therapy does not eradicate TCC of the distal ureters, and upper tract TCC is most likely to occur in patients with CIS of the bladder. Oncol. The preparation, called “Oncovite,” is made by Mission Pharmacal. If all clear, wait a week and begin first maintenance round of 3 weekly instillations (Month 3) interferon in carcinoma in situ of the bladder. Both are highly effective and safe, when used carefully. Intravesical chemotherapy reduces short-term (2 year) tumor recurrence by 20% or less when compared to surgery alone. However, these results with a lower level of evidence should be treated with caution. The dose amount expressed in milligrams varies according to the BCG substrain; the typical dose of BCG used for intravesical instillation is 1-8 x 10. It is a treatment often used after surgery. For a print-friendly version of the following material, click here, A simplified summary of the protocol is also found below Leimert J and Coltman CA: Maintenance BCG immunotherapy of superficial The table on the next page shows the schedule of BCG … Though not statistically significant, in both our review and the EORTC/MRC meta analysis progression was actually higher in patients treated with chemotherapy than in controls. Unused solution is discarded as biohazardous waste after 2 hours. N Engl J Med. Administer drug by dropping 0.2–0.3 mL onto clean surface of skin; then use a sterile multiple-puncture disk to create percutaneous skin punctures. Overall, the recurrence rates for full-dose BCG, one-third dose BCG and one-third dose BCG plus interferon were 50%, 30% and 10% (Pearson’s test, p~O.O3S). BCG must be used within 2 hours of reconstitution. Study. Current Recommendations for BCG Immunotherapy, Donald L. Lamm, MD. situ (TIS): Its impact on management. Treatment should be postponed for at least one week following transurethral resection, biopsy, Nseyo, UO: Photodynamic Therapy. When patients begin to have increased symptoms following BCG instillation, the dose can be reduced to 1/3, 1/10, or 1/100th as needed to prevent significant side effects with subsequent treatment.