Bladder cancer medical therapy

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Steven C. Campbell, M.D., Ph.D.

Overview

The predominant therapy for bladder cancer is surgical resection. Adjunctive chemotherapy, radiation therapy, and immunotherapy may be required.

Medical Therapy

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

• 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.