BCG immunotherapy of lung cancer

Thirty-three patients have undergone BCG intralesional injection into pulmonary tumors. Six received the injection by way of the bronchoscope and 27 were injected percutaneously under fluoroscopic control. The toxicity of this treatment is closely related to PPD reactivity. PPD-negative patients have little fever and malaise. However patients with strongly positive PPD reactions have extensive and prolonged fever. Twenty-six of the 27 patients injected with BCG underwent pulmonary resection. There were no significant postoperative complications. Histologically BCG induces a granulomatous inflammatory reaction, and in the patients who are PPD-positive there is extensive plasma-cell infiltration and de novo germinal center formation within the tumor. Eighty-five percent of the patients with bronchogenic carcinoma and 58 percent of the patients with metastatic cancer are alive and well at a median follow-up of 16 months following pulmonary resection.