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Bacillus Calmette-Guérin (BCG) is a live-attenuated strain of *Mycobacterium bovis* that serves as the gold-standard immunotherapy for non-muscle invasive bladder cancer (NMIBC). In the context of the IMMUNOBCG trial (NCT04806178) led by the University of Campinas (UNICAMP) in Brazil, investigators are evaluating a specific sequential administration protocol. This involves an initial intradermal 'priming' dose of the BCG Moreau RdJ strain (ImmunoBCG) followed by standard intravesical instillations. The mechanism of action relies on the induction of a robust local and systemic immune response; BCG attaches to the bladder wall via fibronectin and is internalized by urothelial and immune cells, triggering the release of Th1-type cytokines and the recruitment of macrophages, natural killer cells, and T-lymphocytes to eliminate malignant cells.
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