Immunotherapy for Bladder Cancer

Immunotherapy is the use of medicines to help a person’s own immune system recognize and destroy cancer cells. Immunotherapy is sometimes used to treat bladder cancer .

Intravesical BCG

BCG is a type of bacteria related to the one that causes tuberculosis. While it doesn’t usually cause a person to get sick, it can help trigger an immune response. BCG can be put right into the bladder as a liquid. This activates immune system cells in the bladder, which then attack bladder cancer cells.

For more details on this treatment, see the section on intravesical therapy.

Immune checkpoint inhibitors (for advanced cancers)

An important part of the immune system is its ability to keep itself from attacking normal cells in the body. To do this, it uses “checkpoints” – molecules on immune cells that need to be turned on (or off) to start an immune response. Cancer cells sometimes use these checkpoints to keep from being attacked by the immune system. But newer drugs that target these checkpoints hold a lot of promise as cancer treatments. At this time, these drugs are used to treat bladder cancers that have spread to other parts of the body (stage IV).

Atezolizumab (Tecentriq®)durvalumab (Imfinzi®), and avelumab (Bavencio®) are drugs that target PD-L1, a protein on cells (including some cancer cells) that helps keep the immune system from attacking them. By blocking PD-L1, these drugs boost the immune system's response against the cancer cells. This can shrink some tumors or slow their growth.

Nivolumab (Opdivo®) and pembrolizumab (Keytruda®) target PD-1, another protein that normally helps keep the immune system in check. Blocking PD-1 can allow the immune system to attack the cancer cells.

Any of these drugs can be used in people with advanced bladder cancer that starts growing again after chemotherapy. Atezolizumab and pembrolizumab can also be used in people who can't get the chemo drug cisplatin (due to things like hearing loss, kidney failure, or CHF).

These drugs are given as intravenous (IV) infusions, usually every 2 or 3 weeks.

Possible side effects

Common side effects of these drugs include:

  • Fatigue
  • Nausea
  • Loss of appetite
  • Fever
  • Urinary tract infections (UTIs)
  • Rash
  • Diarrhea
  • Constipation

Less often, more serious side effects can occur. These drugs work by basically taking the brakes off the body’s immune system. Sometimes the immune system starts attacking other parts of the body, which can cause serious or even life-threatening problems in the lungs, intestines, liver, hormone-making glands, or other organs.

It’s very important to report any new side effects to your health care team right away. If serious side effects do occur, treatment may need to be stopped and you may get high doses of steroids to suppress your immune system.

See the cancer immunotherapy section of our website.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Ingersoll MA, Li X, Inman BA, et al. Immunology, Immunotherapy, and Translating Basic Science into the Clinic for Bladder Cancer. Bladder Cancer. 2018;4(4):429-440.

National Cancer Institute. Bladder Cancer Treatment (PDQ®)–Health Professional Version. November 16, 2018. Accessed at on January 18, 2019.

National Comprehensive Cancer Network, Clinical Practice Guidelines in Oncology (NCCN Guidelines®), Bladder Cancer, Version 5.2018 -- July 3, 2018. Accessed at on January 18, 2019.

Tripathi A, Plimack ER. Immunotherapy for Urothelial Carcinoma: Current Evidence and Future Directions. Curr Urol Rep. 2018;19(12):109.  

Werntz RP, Adamic B, Steinberg GD. Emerging therapies in the management of high-risk non-muscle invasive bladder cancer (HRNMIBC). World J Urol. 2018 Dec 4.  

Last Medical Review: January 30, 2019 Last Revised: January 30, 2019

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