Oncotice (Bacillus Calmette-Guérin (Bcg), Tice)

Oncotice is a live attenuated bacterial vaccine used in the management of bladder cancer, specifically targeting the urothelial carcinoma pathway.

• Non‑muscle‑invasive bladder cancer (NMIBC): Reduces the risk of tumour recurrence and progression.
• Carcinoma in situ (CIS) of the bladder: Provides local immune‑mediated tumour control.
• High‑risk NMIBC after transurethral resection: Serves as adjuvant therapy to decrease recurrence rates.

• Oncotice contains live attenuated Mycobacterium bovis (BCG) that, when instilled into the bladder, is internalised by urothelial and antigen‑presenting cells. This triggers a robust Th1‑type immune response, releasing cytokines such as IFN‑γ and TNF‑α that promote cytotoxic activity against malignant cells and create an immunological environment hostile to tumour growth.

Oncotice may cause a range of adverse reactions following intravesical administration.

Common Side Effects

• Mild cystitis‑like symptoms: dysuria, frequency, urgency.
• Low‑grade fever and chills.
• Hematuria or mild bladder irritation.
• Flu‑like symptoms such as fatigue and myalgia.
• Localized pain at the instillation site.

Serious or Rare Side Effects

• Systemic BCG infection (disseminated BCGitis).
• Severe allergic reactions including anaphylaxis.
• Persistent high‑grade fever or sepsis.
• Significant hematuria requiring intervention.
• Renal impairment secondary to obstructive uropathy.

Before using Oncotice, clinicians should evaluate patient suitability and monitor for adverse events.

• Contraindication: Active urinary tract infection: Delay treatment until infection resolves.
• Immunocompromised status: Increased risk of systemic infection; assess risk‑benefit.
• Prior BCG therapy complications: Consider alternative strategies if severe reactions occurred.
• Pregnancy: Avoid use; potential fetal risk not established.
• Breastfeeding: Not recommended due to unknown excretion in milk.
• Store at 2‑8°C: keep refrigerated, protect from light, do not freeze or shake.

Oncotice may interact with other agents that modify immune function or cause overlapping toxicities.

Major Interactions (Avoid)

• Systemic immunosuppressants (e.g., high‑dose corticosteroids, azathioprine): May diminish BCG efficacy and increase infection risk.
• Live vaccines administered concurrently: Risk of additive infection.

Moderate Interactions (Monitor Closely)

• Antifungal agents such as fluconazole: May affect BCG metabolism indirectly.
• Intravesical chemotherapy agents given in close succession: Potential for increased bladder irritation.
• Cytokine‑targeting therapies (e.g., anti‑TNF agents): May alter immune response to BCG.
• NSAIDs: May mask fever, a key safety signal.
• Anticoagulants: Heightened risk of hematuria.