ORLANDO, FL USA (UroToday.com) - Dr. Ashish M. Kamat presented data his group has been accumulating in an effort to predict response to BCG in patients with non-muscle invasive bladder cancer (NMIBC). He pointed out that BCG is a therapy that has been around for 40+ years, and, although it isn’t perfect, we have not found anything better yet. About 30% of patients will fail, and non-responders tend to progress prior to curative cystectomy, increasing cancer-specific mortality.
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He highlighted the fact that it is an immunologic agent, and that its efficacy is completely based on the dosage…weekly doses for 6 weeks with maintenance courses is the optimal dosing schedule. Other dosing schedules are suboptimal and correlate to weaker immune cytokine responses. Because of this finding, his group has evaluated cytokines comprehensively using a panel, as well as tissue-, urine-, and blood-based markers in patients treated with BCG. Induced IL8 levels (among other cytokines) at the 6th instillation were highest in the responders.
By combining multiple cytokine levels into a nomogram, they were able to stratify responders and non-responders with a 90% accuracy. He highlighted a 2012 trial showing that intradermal BCG may increase the response but also showed a trial from almost 20 years ago showing that intradermal BCG did not have an increased response as well as a recent report demonstrating that different strains may actually have better responses. The Connaught strain had a more durable response rate than did Tice BCG.
AUA/NCI Specialized Programs of Research Excellence (SPORE) Joint Workshop
Presented by Ashish M. Kamat, MD at the American Urological Association (AUA) Annual Meeting- May 16 - 21, 2014 - Orlando, Florida USA
MD Anderson Cancer Center, Houston, TX USA
Written by Phillip Abbosh, MD, PhD, medical writer for UroToday.com