What have we learned after 30 years of BCG intravesical therapy for superficial bladder cancer

Objectives: To discuss the role of bacillus Calmette-Guerin (BCG) immunotherapy in the treatment of superficial bladder cancer after 30 years of clinical experience. Methods: Research on LILACS and PubMed databases, including 31 clinical studies with scientific relevance and importance in the decision-making process. Results: The BCG therapy with induction and maintenance therapy seems to be the best practice in tumors classified as high risk when compared to intravesical chemotherapy. In management of carcinoma in situ, BCG is undoubtedly the therapy of choice, presenting 84.4% of efficacy. As an adjuvant treatment to transurethral resection, there was a 31% reduction in recurrence confirmed in four out of five meta-analyses assessed. The reduction in progression, despite preliminary favorable evidence, still needs further studies to be confirmed. Conclusions: Intravesical BCG is an excellent therapeutic option in cases of carcinoma in situ and it is recommended as an adjuvant treatment in tumors with a high risk of recurrence and progression. (AU) Objetivos: Discutir o papel da imunoterapia com bacilo Calmette-Guerin (BCG) no tratamento de câncer de bexiga superficial apos 30 anos de experiencia clinica. Metodos: Levantamento das fontes de dados PubMed e LILACS, incluindo 31 estudos clinicos de relevância cientifica e importância na tomada de decisao. Resultados: A terapia com BCG com inducao e regime de manutencao parece ser a melhor conduta nos tumores classificados como de alto risco quando comparado a quimioterapia intravesical. No tratamento do carcinoma in situ, BCG e sem duvida o tratamento de eleicao com 84,4% de eficacia. Como regime adjuvante a resseccao transuretral, houve reducao da recidiva em 31% dos casos, comprovada em quatro de cinco meta-analises analisadas. A reducao da progressao, apesar das evidencias preliminares favoraveis, ainda carece de mais estudos para ser comprovada. Conclusoes: BCG intravesical e uma excelente opcao terapeutica em casos de carcinoma in situ e esta recomendado como tratamento adjuvante em tumores com alto risco de recidiva e progressao.(AU)