Learn The BasicsThere are several therapies available to treat bladder cancer. These include chemotherapy, radiation therapy, immunotherapy and targeted therapies.
The type of therapy that a patient will receive will depend on the stage and grade of the cancer, their overall health and their preferences.
Chemotherapy
Chemotherapy refers to the use of drugs to stop the spread of cancer, either by killing cancer cells or stopping them from dividing.
Chemotherapy for bladder cancer can either be intravesical or systemic.
In intravesical chemotherapy, chemotherapy drugs are inserted into the bladder, while in systemic chemotherapy, they are given by mouth or injected into the bloodstream or a muscle.
Intravesical chemotherapy is often used to treat bladder cancer that has not invaded the deep layers of the lining of the bladder, while systemic chemotherapy is used in more advanced stages of bladder cancer.
Chemotherapy drugs that are often used to treat bladder cancer include gemcitabine, cisplatin, carboplatin, paclitaxel, docetaxel, ifosfamide, doxorubicin, methotrexate, vinblastine, mitomycin and 5-fluorouracil (5-FU).
The side effects of chemotherapy may include loss of appetite, nausea and vomiting, hair loss, mouth sores, diarrhea or constipation, reduced white blood cell counts, easy bleeding or bruising and fatigue.
Radiation therapy
Radiation therapy uses high-energy X-rays to treat cancer.
It may be used in patients who cannot undergo surgery. It may also be used after certain types of surgery or as part of treatment for advanced bladder cancer.
Radiation therapy may cause skin changes, such as redness, blistering and peeling in the areas exposed to radiation. Other side effects include nausea and vomiting, bladder symptoms, including burning or pain when urinating, urgency to urinate or blood in urine, diarrhea, blood in stools, fatigue and low blood cell counts.
Immunotherapy
Immunotherapy refers to the use of drugs to help a person’s own immune system recognize and destroy cancer cells.
There are different types of immunotherapy for bladder cancer. These include intravesicular immunotherapy, immune checkpoint inhibitors and antibody drug conjugates.
Intravesicular immunotherapy is directly placed into the bladder and is usually used to treat early-stage bladder cancer. Options include Bacillus Calmette-Guerin (BCG), nadofaragene firadenovec (Adstiladrin) and nogapendekin alfa inbakicept (Anktiva).
Immune checkpoint inhibitors block the action of proteins that keep the immune system in check, keeping it from attacking healthy cells. By removing this “check”, these drugs activate the immune system so it can recognize and attack cancer cells. Immune checkpoint inhibitors that can be used to treat bladder cancer include avelumab (Bavencio), durvalumab (Imfinzi), nivolumab (Opdivo) and pembrolizumab (Keytruda).
Finally, antibody-drug conjugates are therapies that bring chemotherapy drugs directly to the cancer cells using antibodies. Enfortumab vedotin (Padcev) is an antibody-drug conjugate used to treat bladder cancer.
Targeted therapies
Targeted therapies target the changes that occur in cells to make them cancerous.
In bladder cancer, a targeted therapy called erdafitinib (Balversa) may be used.
This therapy inhibits the action of a protein called a fibroblast growth factor receptor (FGFR), which has been altered in patients with bladder cancer.
It can be used if bladder cancer continues to grow despite chemotherapy.
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