Bacillus Calmette-Guerin (BCG, TICE®, TheraCys®)
Pronounced: bah-sill-uhs kahl-met gey-rahn
Classification: Biologic Response Modifier
About Bacillus Calmette-Guerin (BCG, TICE®, TheraCys®)
Bacillus Calmette-Guerin (BCG) is a weakened strain of Mycobacterium bovis, which can be used to prevent tuberculosis. It works against cancer as a biologic response modifier. Biological response modifiers are substances that have no direct antitumor effect, but are able to trigger the immune system to attack tumors. BCG is thought to work by stimulating an immune response and causing inflammation of the bladder wall that, in turn, destroys cancer cells within the bladder.
How to Take Bacillus Calmette-Guerin
BCG is given directly into the bladder (intravesically) through a catheter. A urinary catheter is inserted through the urethra (the tube which carries urine from the bladder to the outside the body), into the bladder. The BCG solution is injected into the catheter, which is then closed off, allowing the medication to remain in the bladder. The catheter may be removed or remain in place for the time the BCG remains in the bladder. The patient is encouraged to roll from side to side and to lie on his/her back to help the medication reach all areas of the bladder. After a predetermined time (usually about 2 hours) the catheter is unclamped, the fluid is drained, and the catheter is removed. If the catheter was already removed you will be asked to void/urinate. Treatments are usually given on a weekly basis, for 6 weeks, followed by treatments once a month, for 6 to 12 months. Your doctor will determine your exact treatment schedule and dose.
Safety Considerations When Receiving BCG
Limit your fluid intake for 4 hours before the procedure so you will be able to hold the medication in your bladder during the treatment. Empty or drain your bladder before the procedure to also make sure you can hold the medication in your bladder during treatment. Do not drink caffeinated drinks for 4 to 6 hours before and for 2 hours after the procedure. Caffeine has a diuretic (need to urinate) and irritant effect, which could make the treatment difficult.
To avoid transmission of BCG to others, for 6 hours after treatment patients should void (urinate) while seated to avoid splashing of urine. Urine voided during this time should be disinfected with 2 cups of household bleach into the toilet water and letting it stand for 15-20 minutes before flushing.
In addition, washing the genital area after urination can prevent irritation from exposure of the skin to BCG.
Immunosuppressants and/or bone marrow depressants and/or radiation interfere with the development of the immune response and should not be used in combination with BCG. Antimicrobial therapy for other infections may interfere with the effectiveness of TICE® BCG. Be sure to tell your healthcare provider about all medications and supplements you take.
Possible Side Effects of BCG
There are a number of things you can do to manage the side effects of BCG. Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:
This medication can cause irritation to the bladder, including difficulty or painful urination (dysuria), blood in the urine (hematuria), and increased urgency (strong feeling of need to urinate) or frequency of urination. Patients are advised to increase fluid intake after administration of this medication to "flush" the bladder. You should report any of the urinary symptoms listed above that last more that 48 hours to your healthcare team for further management instructions.
Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.
Your doctor or nurse can recommend medication and other strategies to relieve aches, pains and generalized malaise.
BCG Infection Reaction
This rare reaction to BCG can occur following exposure to BCG, when given within one week of a biopsy, TUR (trans-urethral resection) surgery, or traumatic bladder catheterization. Symptoms of a BCG reaction include unexplained high fever lasting 24-48 hours or more, chills, confusion, dizziness or lightheadedness (symptoms of low blood pressure), or shortness of breath. You should notify your doctor immediately if you experience any of these symptoms. BCG reaction can also cause pneumonitis (inflammation of the lungs), hepatitis, prostatitis (infection or inflammation of the prostate), epididymal-orchitis (inflammation of the testicles), respiratory distress and other symptoms of sepsis (widespread infection).
Men having this treatment can pass on BCG during sex. To protect your partner from coming into contact with BCG, you should not have sex for 48 hours after each treatment. Use a condom if you have sex at other times during the treatment course and for six weeks after treatment has ended.
This medication should not be given to a pregnant woman except when clearly needed. Women should be advised not to become pregnant while on therapy. Breastfeeding while receiving this medication is not recommended.