Bacillus Calmette-Guerin (BCG) therapy is a common treatment used in patients with early-stage bladder cancer, typically after removal of the tumor. Like other forms of immunotherapy, BCG boosts the body’s natural defenses against cancer. In this case, the immunotherapy uses a vaccine developed from a weakened strain of bacteria that’s similar to the BCG bacteria used in the highly effective tuberculosis vaccine.

Is BCG a form of chemotherapy?

BCG is not chemotherapy. Both types of bladder cancer treatment are administered in the same way—straight into the bladder through a catheter. However, chemotherapy uses drugs to attack cancer cells directly, while BCG—as an immunotherapy treatment—is a vaccine that stimulates the body’s immune system to fight the cancer cells.

When is BCG treatment appropriate for bladder cancer?

A cancer specialist may prescribe BCG treatment for non-invasive bladder cancer, i.e., cancer that developed in the bladder lining without involving deeper layers of the bladder or spreading outside of the bladder. This stage of bladder cancer is referred to as non-muscle invasive bladder cancer (NMIBC). BCG immunotherapy is often the treatment selected for bladder cancers at high risk of tumor recurrence. If there’s a good response to the initial BCG treatment, treatments may be repeated periodically during the next few years as a maintenance measure.

BCG treatment is often prescribed as a follow-up to transurethral resection of a bladder tumor (TURBT), a cancer removal procedure that doesn’t require surgical incision, to help keep the cancer from coming back. In some cases, BCG therapy may be prescribed for patients who had bladder cancer removal surgery. BCG is not an effective treatment for late-stage bladder cancer that has spread outside of the bladder.

How does BCG bladder cancer treatment work?

BCG is an intravesical therapy, which means the vaccine is administered in liquid form directly into the bladder by means of a soft catheter inserted into the patient’s urethra (the tube that empties urine from the body). The treatment activates the attack cells in the body’s immune system so that they target the bladder cancer cells.

To be effective, the BCG solution must come in contact with the cancerous cells. To ensure that the cancer has been exposed to the dosage, a patient having BCG therapy should refrain from urinating for a total of two hours after receiving treatment.

Patients with bladder cancer usually follow a BCG treatment schedule that includes the intravesical therapy once a week for six weeks, starting two or four weeks after surgery.

Does BCG bladder cancer treatment have side effects?

The most common immediate side effects of BCG treatment for bladder cancer are:

A need to urinate more often than usual
Pain or a burning sensation when urinating
Blood in the urine
A low-grade fever and fatigue

These side effects may last a couple of days after each BCG treatment. In some cases, the BCG can spread through the body and cause flu-like symptoms that can be accompanied by skin rash or jaundice. These symptoms may indicate an infection, which should be reported to the treating physician right away. BCG infections can be treated with medication.

What if BCG bladder cancer treatment isn’t effective?

Used to treat NMIBC for more than 30 years, BCG is considered to be one of the most effective biotherapies for cancer. However, some NMIBCs don’t respond well to BCG treatment, resulting in the need for bladder removal surgery. Some patients aren’t good candidates for bladder cancer surgery due to their age or poor health, and others simply refuse to undergo the procedure.

For these reasons and also because of recent global shortages of BCG, cancer researchers have been exploring alternative treatments. A promising immunotherapy developed by bladder cancer specialists at Moffitt Cancer Center combines the use of an immune checkpoint inhibitor, pembrolizumab, with a genetically engineered virus known as CG0070 to treat patients with BCG-unresponsive NMIBC. As part of the treatment, a liquid solution containing the virus is administered into the bladder in the same way as BCG. The goal is to use the virus to provoke an immune response and the checkpoint inhibitor to unleash the immune system’s full power to destroy the cancer cells.

Moffitt recently presented preliminary results from a clinical trial of this immunotherapy approach to the American Association for Cancer Research. The presentation included a report that all patients participating in the trial for a full year saw their bladder cancer fully respond to the treatment, and most participants had similar results after only three months.

How we approach bladder cancer treatment at Moffitt

Every patient who seeks care at Moffitt Cancer Center is unique, and the multispecialty team of experts in our Urologic Oncology Program takes an individualized approach to diagnosing and treating bladder cancer. As a National Cancer Institute-designated Comprehensive Cancer Center, we go above and beyond providing traditional forms of bladder cancer treatment such as surgery, chemotherapy and radiation therapy. In addition to those treatment options, our patients have access to clinical trials and bladder cancer treatments that aren’t yet available in other settings. Our bladder cancer specialists consider the unique details of each patient’s diagnosis, health condition and lifestyle before making recommendations that may include BCG or another immunotherapy as part of a comprehensive bladder cancer treatment plan.

If you’d like to explore bladder cancer treatment options at Moffitt, you don’t need a referral. Simply call 1-888-663-3488 or fill out our new patient registration form online to connect with a cancer expert. At Moffitt, we not only understand the importance of personalized treatment, but we’re committed to helping you get started right away. When you reach out to us, you’ll be able to speak to a cancer expert as soon as possible.