Safe Use of Intravesical Bacillus Calmette-Guérin Immunotherapy for Bladder Cancer During Breastfeeding: A Case Report

Abstract

It is unknown whether intravesical bacillus Calmette-Guérin (BCG) is excreted in human breast milk. The US FDA advocates ceasing nursing due to potential adverse reactions. A lactating woman with bladder cancer who elected to receive intravesical immunotherapy with BCG and denied having ceased nursing her newborn is reported. A 42-year-old woman presented with macroscopic hematuria in the 36th week of her pregnancy. Imaging revealed a mass in the bladder. Cystoscopy and resection were performed after childbirth. Pathological examination revealed pT1 urothelial carcinoma. After a thorough discussion of the treatment options, the patient elected intravesical BCG. The infant received intradermal BCG vaccination 2 weeks before the treatment. As a result, the patient could breastfeed without any inadvertent sequela on herself or the baby.

Plain language summary

Bacillus Calmette-Guérin (BCG) is tuberculosis vaccine. It contains live but attenuated tubercle bacillus. It is also used for bladder cancer treatment, where it is directly instilled into the bladder. BCG activates the local immune response within the bladder to fight cancer cells. The issue of whether BCG instillations into the bladder cause the bacillus to be excreted in breast milk in a lactating woman remains unknown. The US FDA suggests discontinuing breastfeeding when undergoing treatment with BCG due to potential adverse reactions. The authors report on a breastfeeding woman with bladder cancer who elected to receive BCG immunotherapy. The baby received a precautionary dermal BCG vaccination 2 weeks before the patient’s treatment. Ultimately, she was able to complete her treatment while breastfeeding her child without any negative effects on the infant or herself. To the best of the authors’ knowledge, this is the first article showing that breastfeeding may be safe during BCG treatment for bladder cancer.

Keywords::

• BCG
• bladder cancer
• breastfeeding
• case reports
• immunotherapy
• lactation
• surgical oncology
• urology

Author contributions

E Barbur: data curation; writing – original draft; writing – review & editing. T Doganca: data curation; investigation; project administration; visualization’ writing – review & editing. C Obek: conceptualization; data curation; investigation; project administration; supervision; writing – review & editing.

Acknowledgments

The authors thank the patient for her consent and support for the publication and Haydar Durak, MD (Acibadem Mehmet Ali Aydinlar University, School of Medicine, Department of Pathology, Istanbul, Turkey) for providing the pathological images.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained verbal and written informed consent from the patient/patients for the inclusion of their medical and treatment history within this case report.