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BCG vs Mitomycin due to Psoriasis treatment with Skyrizi Hello Is it looks like
Hello all, I am newly diagnosed with NIMBC and have had my first instillation with Mitomycin which my urologist chose over BCG due to my psoriasis and the fact that I am on a biologic (SKYRIZI) for my psoriasis. My histology after the TURBT came back as follows:
High-grade papillary urothelial carcinoma. – Invasion into the lamina propria present. – No muscularis propria present.
My urologist is saying that we caught it early and have a good prognosis. Is this realistic? Am I more at risk for recurrence with Mitomycin vs BCG? This is all new to me. I am 72 and have never had anything like this and want to know what to expect.
ThanksPS – So far (3 days) no major negative effects of instillation – just some urgency and slight urethral pain upon urination.
Thanks
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2 Replies
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What is happening in our immune system is so complex. I think the medical community knows more about interactions of different immune cells to cause psoriasis than they know about cancer cells are killed by immune responses by introducing BCG bacteria into bladder. The heavy weight immune cells which will bladder cancer cells are Killer T-cells (CD8+). To produce millions of Killer T-cells which knows which cells to attack, Helper T-cells (CD4+) are involved. Helper T-cells much get information about specific cancer cells from antigen presentation cells (APC) such as Dendritic cells and Macrophages. In addition to presenting cancer specific antigens, Dendritic cells and Macrophages secrete various cytokines (like hormones) which act as signal among different immune cells. One of cytokines which Dendritic cells and Macrophages is Interleukin-23. Skyrizi for psoriasis treatment is interleukin-23 inhibitors. I dot not know how interleukin-23 affect T-cell responses by BCG treatment and how much it affects the efficacy of BCG treatment when interleukin-23 are inhibited by Skyrizi. I have not located a clinical trial which tested the effect of BCG treatment while patients are on Skyrizi. But, it makes sense that not to use BCG treatment.
In terms of MMC vs BCG, I have thought BCG is better in recurrence free survival rate and progression free survival rate. But a recent study, by looking at multiple clinical studies on BCG and MMC, came to a conclusion that BCG and MMC are comparable both in recurrence free and progression free survival for Ta and T1 papillary urothelial carcinoma.
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Welcome,
The only question I have, is the biopsy saying “High-grade papillary urothelial carcinoma. – Invasion into the lamina propria present. – No muscularis propria present.” If the sample doesn’t have muscle in the specimen that is improper. That is to be sure “margins” are present, meaning nothing got to the muscle. Be sure to ask what the actual wording is and meaning.
DX 5/6/2008 TAG3 papillary tumor .5 CM in size. 2 TURBS followed by 6 instillations of BCG weekly with a second round of 6 after a 6 week wait.
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