Nursing 2050 Written Assignment: Nov 7, 2014 “Bladder Cancer drug BCG in short supply (Mellor, C. (2014, September 11)” read the headline of the Nova Scotia Chronicle Herald on Thursday, September 11, 2014. A manufacturing issue at Merck Canada Inc. in its North Carolina plant put a short supply to BCG (Bacillus Calmette-Guerin strain tice) sold under the name OncoTICE. “BCG is considered “gold standard” and mainstay for treating bladder cancer that has not invaded muscle tissue" as well as functioning as a tuberculosis vaccine. “BCG is an attenuated mycobacterium developed from the Mycobacterium bovis strain. The precise mechanism of action has not been clearly determined; however, the pronounced infiltration of the bladder wall by immunocompetent cells together with the secretion of cytokines into the urine point toward an intense local immune activation after BCG.
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BCG makes initial contact with tumor cells by means of a fibronectin attachment protein, followed by internalization of the BCG in the cells directing a cell-mediated immunologic response. It has been found in recent studies to be a predominantly T-helper/inducer cell-mediated response with persistence of inflammatory cytokines (Th1-type) for a long time within the BCG- induced granulomas, which maybe be key factor in the recurrence-free state of the patient. The prolonged inflammation results in a continuous level of activating cytokines such as the Interleukin-2, Interferon-gamma and Interleukin-12. In laboratory, the two cellular cytotoxic effector mechanisms that have been determined are the commonly implicated leukocyte-activated killer (LAK) cell cytotoxicity and a newly distinguished cytotoxic phenomenon known as the ‘BCG-activated killer (BAK) cell phenomenon.’ The involved effector cells are the activated natural killer cells (NK cells), in which selectively kill malignant targets (Kapoor, R., Vijjan, V. & Singh, P. (2008))”. Research has also proven that the BCG not only has a local immune activation but “…some degree of a systemic response as well, determined by the multiple cytokines that may be found in the BCG-treated patients serum as well”. The dosage of the drug used in “what we call a maintenance or booster fashion, which was more a theoretical use, than actual clinically proven use (Mellor, C. (2014, September 11))”, leading to the decision by the head of capital health urology department Dr. David to go with the clinically proven use of the drug and delay any theoretical use due to it now being a limited resource. BCG is “instilled through a catheter by gravity or slow drip into the bladder to be retained for 1.5-2 hours, after the patient will void. The kinetics of the drug require that the patient should be encouraged to change positions every 30-45 minutes in order to evenly distribute the solution to all portions on the lumen of the bladder for absorption. In the case that the BCG solution becomes too irritable to the bladder intervals between instillations should be lengthened as well a dose modification may be necessary. Generally the dose is a full ampule but patients have responded just as well to half or even one third the dose and report fewer adverse effects (Steinberg, G. (2014)).” The intent is to bring about an immune reaction without bombarding the immune system which may be advantageous to pay consideration to with the drugs short supply. Also another implication a nurse should consider is that the recommendation is to take maintenance doses from monthly or
BCG makes initial contact with tumor cells by means of a fibronectin attachment protein, followed by internalization of the BCG in the cells directing a cell-mediated immunologic response. It has been found in recent studies to be a predominantly T-helper/inducer cell-mediated response with persistence of inflammatory cytokines (Th1-type) for a long time within the BCG- induced granulomas, which maybe be key factor in the recurrence-free state of the patient. The prolonged inflammation results in a continuous level of activating cytokines such as the Interleukin-2, Interferon-gamma and Interleukin-12. In laboratory, the two cellular cytotoxic effector mechanisms that have been determined are the commonly implicated leukocyte-activated killer (LAK) cell cytotoxicity and a newly distinguished cytotoxic phenomenon known as the ‘BCG-activated killer (BAK) cell phenomenon.’ The involved effector cells are the activated natural killer cells (NK cells), in which selectively kill malignant targets (Kapoor, R., Vijjan, V. & Singh, P. (2008))”. Research has also proven that the BCG not only has a local immune activation but “…some degree of a systemic response as well, determined by the multiple cytokines that may be found in the BCG-treated patients serum as well”. The dosage of the drug used in “what we call a maintenance or booster fashion, which was more a theoretical use, than actual clinically proven use (Mellor, C. (2014, September 11))”, leading to the decision by the head of capital health urology department Dr. David to go with the clinically proven use of the drug and delay any theoretical use due to it now being a limited resource. BCG is “instilled through a catheter by gravity or slow drip into the bladder to be retained for 1.5-2 hours, after the patient will void. The kinetics of the drug require that the patient should be encouraged to change positions every 30-45 minutes in order to evenly distribute the solution to all portions on the lumen of the bladder for absorption. In the case that the BCG solution becomes too irritable to the bladder intervals between instillations should be lengthened as well a dose modification may be necessary. Generally the dose is a full ampule but patients have responded just as well to half or even one third the dose and report fewer adverse effects (Steinberg, G. (2014)).” The intent is to bring about an immune reaction without bombarding the immune system which may be advantageous to pay consideration to with the drugs short supply. Also another implication a nurse should consider is that the recommendation is to take maintenance doses from monthly or