Intravesical treatment of bladder cancer: current problems and needs

Especially in patients with superficial bladder cancer being at risk of tumor progression, therapeutic or adjuvant treatment concepts are required. Based upon experimental trials and clinical case reports, intravesical immunotherapy has been developed and further refined in many prospective studies through the last 25 years. Supported by the results of several phase III trials, today instillation therapy with Bacille bilié de Calmette-Guérin (BCG) is accepted as standard therapeutic intervention in carcinoma in situ of the bladder and for prophylaxis of tumor recurrence in superficial, bladder cancer. Current protocols are aiming at the determination of the optimal dosage and regimen and the investigation of the impact of BCG therapy on tumor progression. Furthermore, there is significant clinical need to identify factors predicting the outcome of BCG therapy in a given patient. Based upon the promising results of BCG therapy, several cytokines have been investigated, specifically in order to decrease the side effects of BCG. However, despite of some efficacy and lower side effects, other forms of immunotherapy, e.g., interferon, interleukin 2, or keyhole limpet hemocyanin, must still be regarded as experimental and need further investigation.