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Advances in Urology
Volume 2012 (2012), Article ID 232609, 17 pages
Review Article

Predictive Biomarkers of Bacillus Calmette-Guérin Immunotherapy Response in Bladder Cancer: Where Are We Now?

1Experimental Pathology and Therapeutics Group, Portuguese Institute of Oncology, 4200-072 Porto, Portugal
2ICBAS, Abel Salazar Biomedical Sciences Institute, University of Porto, 4099-003 Porto, Portugal
3Nucleo de Investigação em Farmácia, Centro de Estudos em Saúde e Ambiente (CISA), School of Allied Health Sciences, Polytechnic Institute of Oporto, 4400-330 Vila Nova de Gaia, Portugal
4Department of Gastroenterology, Portuguese Institute of Oncology, 4200-072 Porto, Portugal
5CINTESIS/Department of Biostatistics and Medical Informatics, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
6Laboratory of Medical Investigation (LIM) 14, Faculty of Medicine, University of São Paulo, 01246903 São Paulo, SP, Brazil
7Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, and ICVS/3B’s-PT Government Associate Laboratory, 4710-057 Braga, Portugal
8Molecular Oncology Research Center, Barretos Cancer Hospital, 1331 Barretos, 1478-400 São Paulo, SP, Brazil
9Health Sciences Faculty, University Fernando Pessoa, 4200-150 Porto, Portugal
10Department of Surgical Oncology, Portuguese Institute of Oncology, 4200-072 Porto, Portugal

Received 23 February 2012; Revised 29 May 2012; Accepted 16 June 2012

Academic Editor: Kesavan Esuvaranathan

Copyright © 2012 Luís Lima et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The most effective therapeutic option for managing nonmuscle invasive bladder cancer (NMIBC), over the last 30 years, consists of intravesical instillations with the attenuated strain Bacillus Calmette-Guérin (the BCG vaccine). This has been performed as an adjuvant therapeutic to transurethral resection of bladder tumour (TURBT) and mostly directed towards patients with high-grade tumours, T1 tumours, and in situ carcinomas. However, from 20% to 40% of the patients do not respond and frequently present tumour progression. Since BCG effectiveness is unpredictable, it is important to find consistent biomarkers that can aid either in the prediction of the outcome and/or side effects development. Accordingly, we conducted a systematic critical review to identify the most preeminent predictive molecular markers associated with BCG response. To the best of our knowledge, this is the first review exclusively focusing on predictive biomarkers for BCG treatment outcome. Using a specific query, 1324 abstracts were gathered, then inclusion/exclusion criteria were applied, and finally 87 manuscripts were included. Several molecules, including CD68 and genetic polymorphisms, have been identified as promising surrogate biomarkers. Combinatory analysis of the candidate predictive markers is a crucial step to create a predictive profile of treatment response.