Chemotherapy for Bladder Cancer

Chemotherapy (chemo) is the use of drugs to treat cancer.

How is chemotherapy given?

Chemo for bladder cancer can be given in 2 different ways:

• Intravesical chemotherapy: For this treatment, the chemo drug is put right into the bladder. This type of chemo is used for bladder cancer that's only in the lining of the bladder. It's described in Intravesical Therapy for Bladder Cancer.
• Systemic chemotherapy: When chemo drugs are given in pill form or injected into a vein (IV) or muscle (IM), the drugs go into the bloodstream and travel throughout the body. Systemic chemo can affect cancer cells anywhere in the body.

When is chemotherapy used?

Systemic chemo can be used:

• Before surgery to try to shrink a tumor so that it's easier to remove and to help lower the chance the cancer will come back. Giving chemo before surgery is called neoadjuvant therapy.
• After surgery (or sometimes after radiation therapy). This is called adjuvant therapy. The goal of adjuvant therapy is to kill any cancer cells that may remain after other treatments. This can lower the chance that the cancer will come back later.
• In people getting radiation therapy, to help the radiation work better.
• As the main treatment for more advanced bladder cancers.

Doctors give systemic chemo in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Each cycle typically lasts for a few weeks.

Which chemo drugs are used to treat bladder cancer?

Chemo drugs may be used alone or in combination, depending on what they’re being used for, a person’s overall health, and other factors.

When chemo is given with radiation, the most common drugs used include:

• Cisplatin
• Cisplatin plus fluorouracil (5-FU)
• Mitomycin with 5-FU

When chemo is used without radiation, the most common combinations include:

• Gemcitabine and cisplatin
• Dose-dense methotrexate, vinblastine, doxorubicin (Adriamycin), and cisplatin (DDMVAC)
• Cisplatin, methotrexate, and vinblastine (CMV)
• Gemcitabine and paclitaxel

For some people, the side effects of getting more than one chemo drug might be too much to handle. For those people, treatment with a single drug, such as gemcitabine or cisplatin, may be an option.

Other chemo drugs sometimes used to treat bladder cancer include, docetaxel, paclitaxel, doxorubicin, methotrexate, ifosfamide, and pemetrexed.

Antibody-drug conjugates (ADCs): These medicines are made up of a chemotherapy drug linked to a monoclonal antibody, which is a lab-made version of an immune system protein that’s designed to attach to a specific target on cancer cells. Once inside the body, the antibody part of the ADC acts like a homing device, bringing the chemo directly to the cancer cells.

ADCs that can be used to treat bladder cancer include:

• Enfortumab vedotin (Padcev)
• Sacituzumab govitecan (Trodelvy)

For more on these drugs, see Immunotherapy for Bladder Cancer.

Most bladder cancers are transitional cell (urothelial) cancers, but there are other types as well, including squamous cell carcinoma, adenocarcinoma, and small cell carcinoma. These rare types of bladder cancer may be treated with drugs different from those listed above.

Side effects of chemotherapy

Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemo, which can lead to side effects.

The side effects of chemo depend on the type and dose of drugs given and how long they are taken. When chemo and radiation are given at the same time, side effects tend to be worse. Common side effects of chemo include:

• Nausea and vomiting
• Loss of appetite
• Hair loss
• Mouth sores
• Diarrhea
• Constipation
• Increased risk of infections (because of a shortage of white blood cells)
• Easy bleeding or bruising, even after minor cuts or injuries (due to a shortage of blood platelets)
• Fatigue (because of a shortage of red blood cells)

These side effects usually go away over time after treatment ends. There are often ways to lessen these side effects, some can even be prevented. For instance, drugs can be used to help prevent or reduce nausea and vomiting. Ask your health care team about the side effects your chemo drugs may cause and what can be done to prevent and/or treat them.

Some chemo drugs can cause other, less common side effects. For example, drugs like cisplatin, docetaxel, and paclitaxel can damage nerves. This can sometimes lead to symptoms (mainly in the hands and feet) such as pain, burning or tingling, sensitivity to cold or heat, or weakness. This is called peripheral neuropathy.

Be sure to report any side effects to your medical team so that they can be treated right away. In some cases, the doses of the chemo drugs may need to be reduced or treatment may need to be delayed or stopped to keep side effects from getting worse.