Immunotherapy for superficial bladder cancer. A developmental and clinical overview

Superficial bladder cancer is one of the few solid human malignancies in which immunotherapy has been proved to be effective. Bacillus Calmette-Guérin was the vaccine which opened the door for this innovative approach. In an era of remarkable achievements in biotechnology, it is truly amazing that this throwback to the Stone Age of tumor immunology has not yet been replaced by a more (or equally) effective substitute. Potential candidates are already on the horizon and deserve a comprehensive evaluation. They must show not only that they are devoid of significant adverse effects but that they possess, beyond a doubt, superior antineoplastic activity. Even more remarkable is that one of the oldest vaccines still in use could emerge in a new role as an effective antineoplastic agent. Bacillus Calmette-Guérin has demonstrated an uncanny capacity for effectiveness as therapy for human diseases. Its protective effect against tuberculosis is well recognized, and its contribution to cancer therapy is widely known. A new and increasing repertoire has recently been presented: two separate groups of researchers have employed the vaccine successfully as a vehicle to express antigen-encoded genes from other pathogens. The exciting aspect of these recent studies resides in the demonstration that the altered vaccine is able to induce humoral and cell-mediated immune responses to the recombinant antigens, including the human immunodeficiency virus (HIV). Thus, BCG once more attracts enormous interest from the scientific community for its versatility and potential as a therapeutic agent.