# Intravesical BCG

Source: https://onco.cc/drugs/bcg-intravesical/  
OnCo record `bcg-intravesical` (Treatment). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A weakened tuberculosis vaccine put directly into the bladder. Since 1976 it has been the most effective treatment for early bladder cancer, and it remains in chronic short supply.

## Summary

Induction (6 weekly instillations) plus 1-3 years of maintenance reduces recurrence and progression in high-risk NMIBC. Global shortages since 2012 (single US manufacturer, Merck) have forced dose-splitting and priority rules. New combinations: durvalumab + BCG (POTOMAC, approved 2026), N-803 + BCG (Anktiva, 2024), and recombinant BCG (VPM1002) in trials. About 30-40% of patients become BCG-unresponsive.

## Fields

- Kind: Treatment
- Status: standard-of-care
- Last checked: 2026-09-07
- Brand: TICE BCG
- Modality: Live bacterial immunotherapy (intravesical)
- Mechanism: Attaches to urothelium via fibronectin, is internalised, and triggers a Th1 innate and adaptive immune response with trained immunity.
- Approvals: US 1990: Carcinoma in situ of the bladder (TICE BCG)
- Dosing: Intravesical; Weekly ×6 induction, then 3 weekly instillations at months 3, 6, 12, 18, 24, 30, 36 (SWOG maintenance) for high-risk disease

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/BCG_vaccine
- Wikipedia: https://en.wikipedia.org/wiki/BCG_vaccine

## Connected records

- cancers: [Bladder & urothelial cancer](https://onco.cc/cancers/urothelial/)
- technologies: [BCG manufacturing and the bladder cancer BCG shortage](https://onco.cc/technologies/bcg-vaccine-manufacturing/), [Bladder EpiCheck urine methylation test](https://onco.cc/technologies/bladder-epicheck/), [Intravesical therapy (BCG, chemotherapy, devices, gene and viral therapy)](https://onco.cc/technologies/bcg-and-intravesical-therapy/)
- companies: [Merck & Co. (MSD)](https://onco.cc/companies/merck/)
- terms: [BCG-unresponsive](https://onco.cc/terms/bcg-unresponsive/), [Non-muscle-invasive vs muscle-invasive bladder cancer (NMIBC / MIBC)](https://onco.cc/terms/nmibc-vs-mibc/)
- trials: [POTOMAC](https://onco.cc/trials/potomac/), [QUILT 3.032](https://onco.cc/trials/quilt-3-032/)
- pairings: [Durvalumab + BCG in BCG-naive high-risk NMIBC](https://onco.cc/pairings/durvalumab-plus-bcg/)
- ideas: [Engineered bacteria that live in tumours and manufacture drugs there](https://onco.cc/ideas/idea-bio2-engineered-bacteria-payloads/), [Train the bone marrow to make better anti-tumour immune cells](https://onco.cc/ideas/idea-bio2-trained-immunity-priming/)
- pathways: [Myeloid suppression: TAMs, MDSCs & don't-eat-me signals](https://onco.cc/pathways/myeloid-suppression-axis/)

---
JSON: https://onco.cc/api/v1/entities/bcg-intravesical.json