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Mr Lockyer and Mr Gillatt (March 2001 JRSM, pp. 119-123) refer to the importance of fibronectin in promoting adhesion of BCG to bladder tumour cells. The basic mechanism is likely to be the same for all types of BCG, since all are ultimately derived from the original developed at the Pasteur Institute. According to some reports, response rates are adversely affected by medications that interfere with clotting1.
I am surprised that Lockyer and Gillatt ask their patients to retain intravesically administered BCG for only one hour. The manufacturers of Tice BCG (widely used in the UK as a 12.5 mg preparation) recommend two hours. Whilst some patients with irritative lower urinary tract symptoms will be unable to retain the preparation for so long, clinicians should bear in mind that the immunotherapeutic response depends at least partly on the time available for BCG to adhere to the bladder mucosa.