PTU - Polskie Towarzystwo Urologiczne
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Pathogenesis of BCG therapy in superficial bladder cancer
Article published in Urologia Polska 2005/58/2.


Tomasz Demkow
Klinika Nowotworów Układu Moczowego, Centrum Onkologii - Instytut im. M. Skłodowskiej-Curie w Warszawie
Kierownik kliniki: dr hab. Tomasz Demkow


urinary bladder, superficial bladder carcinoma, BCG-therapy, mechanism of action, inflammation, cytotoxicity


introduction and objectives
BCG-therapy is generally regarded as most effective immunotherapy for superficial bladder transitional cell carcinoma. The mechanism of anti-tumor activity of BCG is not known clearly. However many studies suggest that it is dependent on specific inflammatory response in the bladder wall. Intravesical BCG therapy for superficial bladder carcinoma is considered as most effective adjuvant therapy superior to other chemotherapeutic agents.
material and methods
A retrospective review of the world literature using MEDLINE was performed searching for various aspects of immunological response to BCG therapy in vitro and in vivo in humans as well as in animals.
The efficacy of BCG requires subsequent order of events starting from fibronectin ? mediated attachment of mycobacteria to bladder epithelial cells, through induction of specific panel of inflammatory cytokines (IL1, IL6, TNFa, INFg) leading to accumulation and local proliferation of BCG-sensitized cells. The final step is the generation of specific cells (BCG activated killers ? BAK cells) cytolytic against tumor. Cytotoxicity of BAK cells is attributed to the pore-forming perforins.
The efficacy of intravesical BCG-immunotherapy bases on the sequence of immunological events leading to the developments of granulomatous inflammation in the bladder wall.


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Tomasz Demkow
Klinika Nowotworów Układu Moczowego
02-781 Warszawa
ul. Roentgena 5
tel. (022) 546 24 62