Transitional cell carcinoma medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The predominant therapy for transitional cell carcinoma is surgical resection. Adjunctive chemotherapy, radiation therapy, and immunotherapy may be required.

Medical Therapy

Transitional Cell Carcinoma of Bladder

Immunotherapy

• Immunotherapy is a type of biological therapy that uses the immune system to help destroy cancer cells.
• Bacillus Calmette–Guérin (BCG)

• Immunotherapy by intravesicular delivery of Bacillus Calmette–Guérin (BCG) is often used to treat and prevent the recurrence of superficial tumors.
• BCG is a vaccine against tuberculosis that is prepared from attenuated live Mycobacterium bovis, that has lost its virulence in humans.
• BCG immunotherapy is effective in up to 2/3 of the cases at this stage, and in randomized trials has been shown to be superior to standard chemotherapy.
• The mechanism by which BCG prevents recurrence is unknown, but the presence of bacteria in the bladder may trigger a localized immune reaction which clears residual cancer cells.

Chemotherapy

• Chemotherapy may be given to patients with stage II and III disease either before or after surgery to help prevent the tumor from returning.
• For early disease (stages 0 and I), chemotherapy is usually given directly into the bladder.
• Intravesical chemotherapy

• During intravesical chemotherapy, the drugs are placed into the bladder through a urinary catheter.
• Intravesical chemotherapy may be given instead of BCG or if the bladder cancer doesn’t respond to BCG.
• Mitomycin is the drug most often used in intravesical chemotherapy.

• Systemic chemotherapy

• During systemic chemotherapy, the drugs are given intravenously.
• Systemic chemotherapy may be a treatment option for bladder cancer that has spread to other tissues near the bladder and bladder cancer that has spread to other parts of the body.
• Chemotherapy is recommended before a radical cystectomy (called neoadjuvant chemotherapy) for many people with bladder cancer that has grown into the muscle layer of the bladder wall. It is also often given after a radical cystectomy (called adjuvant chemotherapy) to people with high-risk features such as cancer that has spread to lymph nodes.

Radiation therapy

• Radiation therapy may be the main treatment for people who can’t have surgery.
• External beam radiation therapy is the type of radiation treatment that is most often used to treat bladder cancer.
• Palliative radiation therapy may be given to relieve symptoms caused by advanced bladder cancer.

Transitional Cell Carcinoma of Renal Pelvis and Ureter

Chemotherapy

• Chemotherapy is used to treat cancer of the renal pelvis or ureter that has spread to the lymph nodes or to other parts of the body.
• In patients with metastatic transitional cell carcinoma, combination chemotherapy has produced high response rates and occasional complete responses.
• It may be offered after surgery (called adjuvant chemotherapy) if cancer is found in the lymph nodes removed during surgery.
• Sometimes it is also given before surgery (called neoadjuvant chemotherapy) if the cancer appears more advanced.
• The most common chemotherapy drug combinations used are:

Regimens
GemCIS: Gemcitabine (Gemzar) and cisplatin (Platinol AQ)
MVAC: Methotrexate, vinblastine (Velbe), doxorubicin (Adriamycin), and cisplatin

• GemCIS is used most often because it causes less severe side effects than the other combination.
• Other chemotherapy agents that have shown activity in metastatic transitional cell cancer include the following:

• Paclitaxel
• Ifosfamide
• Gallium nitrate
• Pemetrexed

• Ifosfamide, gallium, and pemetrexed have shown limited activity in patients previously treated with cisplatin.