Mycobacterial Cell Wall Possible Alternative to BCG

Mycobacterial cell wall therapy may be an alternative to BCG in thetreatment of carcinoma in situ (CIS) of the bladder, Dr. Alvaro Morales,of Queen's University, Kingston, Ontario, reported at the AUA meeting.

The cell walls of Mycobacterium phlei (an organism similar toM bovis) were instilled into the bladder of 68 patients at a dose of 4mg once a week for six weeks, then monthly for one year.

At 12-week follow-up, 40 of 64 evaluable patients had responded to treatment:33 with complete response and 7 with partial response. All 9 patients remainingin the study at 78-week follow-up were complete responders, Dr. Moralessaid. Of those who had failed previous BCG therapy, 48% responded to cellwall treatment.

Adverse events were "much less intense than with BCG, though ofa similar kind," he said, listing fever, chills, and malaise of "veryshort duration." No sepsis occurred.

"At this low dose, mycobacterial cell wall was less effective thanBCG, but dose escalation studies are needed," Dr. Morales said, addingthat mycobacterial cell wall could potentially be used as a rescue agentfor BCG failures.