Bladder Cancer Treatment Options
- Treatments for bladder cancer that has spread may not cure the disease, but they can help you live longer and feel better.
- Chemotherapy is the foundation of treatment for advanced bladder cancer, because it kills cancer cells throughout your body.
- New immunotherapies rev up your immune system to treat your cancer. They don’t work for everyone, but the results can be dramatic when they do work.
You may have been diagnosed with an advanced bladder cancer to start. Or you might have discovered that your cancer had spread after being treated for an early-stage cancer. Either way, your treatment direction will change.
A New ApproachRead More
“We have to take a systemic approach, which means treating the whole body,” Dr. Arjun Balar, assistant professor of medicine and director of the Genitourinary Cancer Program at the NYU Perlmutter Cancer Center, tells SurvivorNet. He adds that platinum-based chemotherapy is still the backbone of treatment for advanced bladder cancer. But increasingly, doctors are using immunotherapy.
Finding the Right Treatment
Late-stage bladder cancer isn’t considered curable in most cases. But it is treatable. To have the best chance for a good outcome, experts recommend assembling the right treatment team.
“This is where the expert knowledge at cancer centers comes in particularly handy,” Dr. Jay Shah, associate professor at Stanford University and a cancer surgeon at the Stanford Cancer Center tells SurvivorNet.
At a comprehensive cancer center, you’ll be seen by a team of experts, including:
- Medical oncologists
- Radiation oncologists
“You want to give the patient the best chance at defeating this cancer, but you don’t want to make the patient so weak or harm them from treatment that they don’t do well,” Dr. Shah says. “This is where the expert knowledge at cancer centers comes in particularly handy.”
Chemotherapy is the mainstay of treatment for advanced bladder cancer. This therapy uses strong drugs to kill cancer cells all over the body. That makes it a good approach for treating bladder cancer once it has spread. Sometimes doctors combine chemotherapy with radiation therapy to boost its effectiveness.
The aim of chemotherapy treatment is to slow your cancer, relieve your symptoms, and help you live longer. “The overall goal is to try to kill as many cancer cells as possible with the chemotherapy,” Dr. Shah says.
Choosing a Chemo Type
The type of chemo you get can vary depending on your cancer center. Cisplatin should be part of the mix. It’s the drug that has been shown most effective against bladder cancer.
Yet up to 70% of people with advanced bladder cancer aren’t eligible for cisplatin treatment, Dr. Balar says. It may be that their cancer has made them too sick for cisplatin, or they have nerve or kidney problems. If you can’t take cisplatin, your doctor might try another type of chemo called carboplatin.
Carboplatin doesn’t work as well against advanced bladder cancer as cisplatin. And until recently, doctors didn’t have other good treatment options for people who couldn’t take cisplatin. Then immunotherapies came along.
“If someone has very advanced metastatic bladder cancer and can’t get cisplatin-based chemotherapy, then we can try to use immunotherapy to prolong that patient’s life and control the cancer,” Dr. Shah says.
Immunotherapy is a new type of treatment for advanced bladder cancer. It uses the power of your own immune system to fight your cancer. “Where immunotherapies actually have the greatest impact is in the people who are not eligible for cisplatin,” Dr. Balar says.
A group of immunotherapies called PD-1 and PD-L1 inhibitors block proteins on cancer cells. These proteins normally prevent T cells — killer cells of your immune system — from attacking them. “By doing so, the T cell is now reinvigorated and is able to do what it’s supposed to do, which is to attack the cancer cell,” Dr. Balar says.
Immunotherapies for bladder cancer include:
- Atezolizumab (brand name: Tecentriq)
- Avelumab (brand name: Bavencio)
- Nivolumab (brand name: Opdivo)
- Pembrolizumab (brand name: Keytruda)
Tecentriq and Keytruda are now FDA-approved as first treatments for people who can’t take cisplatin.
Dr. Shah cautions that immunotherapy doesn’t work in most people. But when it does work, “there are responses that are phenomenal.”
Keeping Hope Alive
Learning that your cancer has spread can be frightening. But with so many new treatment options available, people are living longer than ever before.
Dr. Shah once had a patient named Jerry with advanced bladder cancer who’d been told he had only a couple of months to live. Jerry was afraid he wouldn’t survive long enough to attend his daughter’s wedding. Not only was he there for her wedding, but he’s still alive, five years later.
“For me, that’s the goal for everybody. To give them that hope and to give them their life back,” Dr. Shah says.