Open Access

ARTICLE

Biomarkers in patients treated with BCG: an update

Julia Klap, Marianne Schmid, Kevin R. Loughlin

Department of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
Address correspondence to Dr. Julia Klap, Department of Urology, Brigham and Women’s Hospital, 45 Francis Street, Boston, MA 02115 USA

Canadian Journal of Urology 2014, 21(4), 7335-7343.

Abstract

Introduction: Bacillus Calmette-Guérin (BCG) instillations are the recommended treatment for non-muscle invasive bladder cancer but high recurrence and progression rates remain after treatment. Despite patients risk stratification, BCG effectiveness remains unpredictable. A close, invasive and expensive follow up is mandatory. To improve or even replace this heavy surveillance in this high risk population, validated biomarkers were developed.
Materials and methods: To identify the useful tools for the urologist in monitoring bladder cancer patients, we reviewed the literature focusing on plasma and urinary biomarkers of BCG-therapy outcome. Articles dated from 1988 to 2013 including specific keywords (urinary bladder neoplasm, biological markers, intravesical administration, recurrence) were examined and relevant papers were selected.
Results: Before treatment initiation, genetic polymorphisms of multiple agents (cytokines, matrix-metalloproteinases) were found to become very useful to tailor therapy and monitoring. Those biomarkers belong to personalized medicine which is a topic of great interest today, but still need to be validated in cohorts from different ethnicities.
During instillations, cytokines (IL-2, IL-8, IL-6/IL-10) were reported to be reliable to determine treatment response and efficacy. Further studies are needed to confirm results and standardize thresholds.
Conclusions: No recommendations for everyday practice can be established today, but a combination of several markers and clinicopathological characteristics may be the future. As bladder cancer diagnosis and management are evolving, practicing urologists should be aware of and utilize bladder cancer markers in clinical practice.

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Keywords

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