Bacillus Calmette-Guérin in superficial bladder cancer: consensus and controversies

In this overview, Bacillus Calmette-Guérin (BCG) immunotherapy in superficial bladder cancer items are discussed on which consensus has been reached and on which controversies exist. The evaluation of the optimal route of administration has shown that intravesical instillation of BCG alone is accepted as the best route of administration. In searching for the appropriate BCG strain, the analysis of the results of 6 substrains has made clear that no particular strain has shown superiority over others. In finding the optimal treatment schedule there is strong evidence that maintenance therapy is superior to induction therapy alone. No consensus has been reached about the optimal dose for BCG therapy nor about how the toxicity of BCG treatment can be reduced. Although some reports have stated that BCG immunotherapy is superior to chemotherapy for the treatment of patients with superficial bladder cancer, more data are needed to prove this statement. In conclusion, although BCG has been proven to be very effective in the treatment of patients with superficial bladder cancer, it is certainly not a panacea for all patients with superficial bladder cancer.