Intravesical BCG immunotherapy for Non-Muscle Invasive Bladder Cancer during COVID-19 pandemic: Mutual impact and implications

Abstract

Urinary bladder cancer (BC) is the tenth most common malignancy worldwide, with higher incidence in developed nations. The disease is four times more common in men than women, with 90% of cases diagnosed at the age of 55 years and above. An early stage of tumor that invades up to the lamina propria, but not into the smooth muscle of urinary tissue accounts for 75% of all newly diagnosed BCs and is termed as Non-muscle invasive bladder cancer (NMIBC). The most effective treatment for NMIBC since last three decades is its removal by transurethral resection followed by intravesical immunotherapy with Mycobacterium bovis Bacillus Calmette-Guerin (BCG). The COVID-19 pandemic situation has negatively impacted disease management as well as patient care for many life-threatening diseases, including BC. In order to adapt the clinical practice during pandemic, certain adjustments have been recommended in BCG therapy regimen of NMIBC by urologists. Interestingly, there are certain reports of possible protective role of BCG against COVID-19 in NMIBC patients undergoing BCG immunotherapy, while others warn of higher cumulative incidence of COVID-19 infection in NMIBC patients receiving BCG instillations. In this study, we plan to conduct an extensive literature review in order to critically analyse the mutual interplay of BCG immunotherapy for NMIBC and COVID-19 incidence and associated risk. It will not only help us draw conclusions regarding bilateral impact of BCG therapy for NMIBC and COVID-19 but also serve as a basis of pragmatic improvisation of guidelines for BCG therapy of NMIBC during COVID-19 health crisis.