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9 - The effectiveness of combined intravesical BCG+Interferon-alfa 2b in patients with superficial bladder cancer in whom BCG alone previously failed and the relationship with tumor p53 and serum anti-p53 antibodies
Eyüp Gümüş, Kaya Horasanlı, Orhan Tanrıverdi, Uğur Boylu, Volkan Yollu, Cengiz Miroğlu
Objective: Our aim is to determine the effectiveness of combined low dose BCG and interferon-alfa 2b (IFN-alfa 2b) in patients, in whom BCG previously failed, and also the importance of tumor p53 expression and serum p53 antibodies on follow-up.
Materials and Methods: Between September 1999 and November 2003, 10 patients ages between 51-74 years (median 63) who previously failed intravesical BCG treatment are included in this study. These patients were undertaken to transurethral tumor resection and they were given 27 mgs of Connaught BCG (1/3 dose) and 50 million units of IFN-2b once a week for 6 weeks. Serum anti-p53 abs were detected by enzyme linked immunosorbent assay (ELISA). During subsequent evaluation, each specimen in its entirety was examined with accepted positive cut-off criteria of 20% nuclear stainig. Median follow-up was 41 (32-50 months) months.
Results: 7 of 10 patients (70%) had no tumor recurrence and 3 had recurrence during follow-up. Patients with recurrences in cystoscopic controls were treated with transuretral resection (TUR-BT) and no additional intracavitary chemotherapy given these patients. No stage and grade progression was observed. This combination therapy is tolerated well by all patients and no side effects were observed. Three patients (30%) had positive tissue p53 and one of these patients (10%) had positive serum anti-p53 antibody. Both tumor p53 protein and serum anti-p53 protein were positive in one of the patients with recurrence.
Conclusions: The results of combined intravesical BCG and IFN-alfa 2b immunotherapy for superficial bladder cancer, in whom BCG previously failed, were encouraging. Tumor p53 and serum anti p-53 antibody positivity were not seen as a indicator of progression in these limited number of patient with long term follow-up.
Keywords: Bladder cancer, BCG, Interferon-alfa 2b, p53
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