Intravesical bcg and second primary malignancies

LETTERS TO THE EDITOR

INTRAVESICAL BCG AND SECOND PRIMARY MALIGNANCIES To the Editor: We read the article, “Intravesical Bacillus Calmette-Guerin and Second Primary Malignancies,” by F? Guinan, et al., published in the May issue (vol. 33, pages 380-381, 1989) of UROLOGY. They refer to our article, “Does Bacillus Calmette-Guerin Immunotherapy Accelerate Growth and Cause Metastatic Spread of Second Priet al., mary Malignancy ?” by 0. P Khanna, published in the June issue (vol. 31, pages 459-468, 1988) of UROLOGY. We were surprised and distressed to note that the authors did not read our article carefully and thus, have misinterpreted our results. The first discrepancy appears in the opening paragraph: “A recent report has suggested that intravesical bacillus Calmette-G&in (BCG) therapy may result in an increased incidence of second primary neoplasm .” We did not state, discuss, or imply that BCG increases the incidence of second primary malignancies. Instead, we have brought to the attention of all that BCG immunotherapy may accelerate growth and cause metastatic spread of a growing second primary malignancy that remained undetected at the start of BCC therapy. The second discrepancy concerns the statement by Guinan et al. that “Khanna et al. recently reported that in 29 of 150 patients receiving intravesical BCG for transitional cell carcinoma of the bladder second primary tumors developed.” The first problem with that statement is that, as stated in our article and noted in our graphs, not all of the 150 patients were treated with BCG, some were treated with ADR. Second, we did not suggest that BCG may have been causative in the development of second primary malignancies. The third problem is that their statement makes it sound as if all 29 second primary malignancies developed after starting therapy. We clearly stated that “26 patients with other primary malignancies that had developed months to years before intravesical therapy did not show acceleration or spread of those second tumors.” We also stated that in 10 patients, primary malignancies were manifested after BCG therapy was begun. In 5 of these patients the second

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primary tumor developed within three months of the start of BCG therapy, and all these patients showed acceleration of growth and distant metastases developed in 4. The time relationship between the starting point of second primary tumor development and the starting point of BCG treatment may be crucial in determining whether BCG will eradicate or accelerate the tumor. This was the point of our article and Guinan et al. seem to have overlooked it. We are requesting that this letter to the editor be published in UROLOGY and that Guinan et al. respond to our concerns. Om I? Khanna, M.D. Professor and Director Division of Urology Hahnemann University Philadelphia., Pennsylvania 19102

REPLY

OF DR. GUINAN

To the Editor: We acknowledge Dr. Khanna’s distinction between ‘
Chief,

Section

Patrick Guinan, M.D. of Uro-Oncologic Therapeutics Cook County Hospital Chicago, Illinois 60612

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