Improving Compliance of BCG Immunotherapy: Practical Approaches to Managing Side-Effects

Abstract: Adverse events (AEs) following intravesical bacillus Calmette-Guérin (BCG) therapy are directly related to reduced compliance, leading to treatment cessation and incomplete treatment. Dr Rischmann and his team designed a prospective study to determine whether prophylaxis with ofloxacin could improve the tolerance of BCG in the treatment of transitional cell carcinoma (TCC) of the bladder. A secondary objective was to investigate the effect on efficacy. The use of ofloxacin significantly decreased the incidence of class 2 or higher AEs (moderate or severe) between instillations four and six. With ofloxacin the percentage of class 3 AEs was also significantly decreased between instillations one and nine. Although ofloxacin reduced AEs involving the lower urinary tract, it did not prevent class 1 AEs. Compliance to full BCG treatment was also improved. Ofloxacin did not appear to impair the efficacy of BCG during 12 mo after treatment. The use of prophylactic ofloxacin 200mg given twice after BCG instillations appears to be a simple and practical method of improving BCG tolerability yet maintaining efficacy. [Copyright &y& Elsevier]