ABSTRACT
The most effective intravesical treatment of non-muscle-invasive bladder cancer is instillation of live Mycobacterium bovis bacillus Calmette-Guérin (BCG). BCG stimulates the release of cytokines, contributing directly or indirectly to its effectiveness. However, the function of specific cytokines is not well understood. We have undertaken a nonsystematic review of primary evidence regarding cytokine detection, activation and response in BCG patients. Cytokines IL-2, IL-8 and TNF-α appear to be essential for effective BCG therapy and nonrecurrence, while IL-10 may have an inhibitory effect on BCG responses. IL-2, IL-8, TRAIL and TNF-α are potentially predictive of response to BCG. Alterations in genes encoding cytokines may also affect responses. There are significant data showing the association of certain cytokines with successful BCG treatment, and which may be useful predictive markers. Isolating those cytokines mediating efficacy may hold the key to ameliorating BCG's side effects and improving efficacy and patient compliance.
Subject(s)
BCG Vaccine/administration & dosage , Cytokines/metabolism , Urinary Bladder Neoplasms/metabolism , Urinary Bladder Neoplasms/therapy , Administration, Intravesical , Humans , Prognosis , T-Lymphocyte Subsets/immunology , T-Lymphocyte Subsets/metabolism , Treatment Outcome , Urinary Bladder Neoplasms/immunologyABSTRACT
Many malignancies metastasise to the skeleton. This often results in a relatively unique pain process, which dramatically affects a patient's quality of life. With one in three members of the population likely to develop cancer at some stage in their lives, the prevalence of bone metastases is high. Despite the large financial investment on therapies for these patients, treatment is still suboptimal. In this article, the various treatments available are reviewed. Opiates and bisphosphonates, the mainstays in current practise, are covered in detail, and evolving therapies that may shape future management are also discussed.