FIG. 41:  Another immunotherapeutic drug, keyhole limpet hemocyanin (KLH) has been compared with mitomycin in a large Phase 3 randomized control trial of almost 300 patients.^[26]  Unfortunately, KLH appeared to be much less effective than mitomycin with respect to recurrence rate.  However, although progression was rare, in the higher-risk patients there was a trend for less progression in the KLH group.  So KLH might be an alternative to BCG in high-grade tumors, although it is registered in only a few countries.