Nucleotide Oligomerization Domain-like Receptor 4 (NLR4) Gene Expression and Interleukin 1-β (IL 1-β) Level in Urine Samples Before and After Intravesical BCG Therapy for Treatment of Bladder Cancer

Abstract

he treatment of bladder cancer depends on how deeply the tumor invades into the bladder wall with non-muscle invasive bladder cancer treated mostly with TURBT with or without intavesical chemotherapy or immunotherapy. Immunotherapy by intravesical BCG instillation is used to treat and prevent the recurrence of NMIBC. BCG immunotherapy is effective in up to 2/3 of the cases at this stage, and in randomized trials has been shown to be superior to standard chemotherapy. The exact mechanism by which BCG prevents recurrence is unknown. However, it has been shown that the bacteria are taken up by the cancer cells. The infection of these cells in the bladder may trigger a localized immune reaction which clears residual cancer cells. BCG is delivered as induction and a maintenance course. The induction course consists of 6-weeks course of intravesical BCG. This is followed by a maintenance course. Side effects of BCG therapy include cystitis, prostatitis, epididymo-orchitis, balanitis, ureteral obstruction, bladder contraction, myco-bacterial osteomyelitis, reactive arthritis, mycobacterial pneumonia, granulomatous hepatitis, granulomatous nephritis, interstitial nephritis, infectious vasculitis and disseminated infection.