By Rob Truscott
BCG is a long name that many of us only guess at the pronunciation (Bacillus Calmette-Guerin). But most people aren’t aware it has been part of Canadian medical history for decades, and how a Canadian was involved in its use as a cancer treatment.
In this podcast, hosted by Collin Whitehouse, the unique and exciting history of BCG is explained by Dr. Alexander Zlotta. Dr. Zlotta is a Professor in the Department of Surgery and Urology at University of Toronto, Director of UroOncology at Mount Sinai, associate editor at Frontiers in Oncology and the Bladder Cancer journal, and staff member in the Division of Surgical Oncology at the Princess Margaret Cancer Center. Dr. Zlotta is also joined by NMIBC patient Jonathan Peterson.
The development of BCG goes back over 100 years and started as an infection in the milk of cows. Researchers discovered the BCG bacteria was similar to the Tuberculosis bacteria found in people and after research and clinical trials, it became a TB vaccine used in humans. Production of BCG is very challenging and was initially grown in a paste that was made from potatoes and other unique products (including bile). In 2022, the microbiology is now being done with more modern methods. Many years of study recognized that not only was it effective as a TB vaccine but it also had cancer fighting abilities by rebuilding the human immune response, hence the term “immunotherapy”.
The diverse history and connection to decades of autopsy research goes back to the 1920s and 1930s, when it was noted that people who died of TB had less instances of cancer. This led to research that was done in the 50s and 60s, when researchers noted the immune response similarities between some cancer cells when BCG was placed in close proximity .
As bladder cancer tumours have a high tendency to return, the conversation continues to discuss how BCG is now used for NMIBC. By instilling BCG into the bladder, the immune system response is triggered to fight the TB element of BCG, which also has the same effect as triggering a boosted immune system to fight off bladder cancer tumours.
BCG treatment has many challenges for protocols and precautions in addition to various side effects for patients. Jonathon talks about how patients will spend time switching sides while laying down to ensure that the BCG solution coats the entire bladder. Jonathan also outlines the sequence of events that a BCG treatment day entails. From traveling to the treatment center until the end of the day, he finally emerges from isolation after any BCG remaining in his system is fully diluted and no longer poses an impact to anyone else in his household. Currently at 18 treatments, Jonathan is in the middle of his full treatment program.
Due to world-wide shortages of BCG, dose sizes have been a popular topic of discussion in the medical community. Oncologists need to triage the patients to better assess the best treatment regimen. Many patients also have challenges with the side effects of BCG treatments. In the podcast, Dr. Zlotta highlights the challenges with immunotherapy compared to chemotherapy. Long term impacts and side effects of the full 3-year program have shown challenges for several patients, which Dr. Zlotta talks about in detail.
Jonathan’s side effects are mostly on track and he discusses the mental impacts of knowing what he will be going through during the many treatments. Worth noting is while talking now about long-term outcomes, Jonathan shares how he feels the positive impacts of BCG, although not enjoyable at the time of treatment, is the best option for the best outcome.
In closing, Dr Zlotta highlights the many changes the cancer community has seen in his 35 years, yet the use of BCG has not changed as the most widely recommended treatment for NMIBC.
There are currently 80,000 Canadians living with a bladder cancer diagnosis and 12,000 more will be diagnosed this year. At Bladder Cancer Canada, we are doing everything we can to increase awareness of this devastating disease to as many Canadians as possible – including this podcast that we created for Bladder Cancer Awareness Month.
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Listen to the podcast on Buzzsprout here or on Spotify here.
This podcast/blog is generously sponsored by Bristol Myers Squibb, Pfizer Canada and EMD Serono.
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