Bladder Cancer Treatment: Immunotherapy vs Chemotherapy

People may know chemotherapy as a cancer treatment more readily than immunotherapy. But immunotherapy is gaining traction, and for good reason.

Immunotherapy is a promising advancement in the treatment of many cancers, including bladder cancer. It has even become the first line of treatment for some cancers.¹

Bladder cancer has a long track record with immunotherapy. One of the first immunotherapies approved by the U.S. Food and Drug Administration was for bladder cancer, in 1990.^2,3

So, how does immunotherapy differ from chemotherapy? And what is right for you?

What are immunotherapy and chemotherapy?

Both types of treatments target tumor cells, but they use different methods. Immunotherapy acts on your immune system, while chemotherapy acts on the cancer cells growing inside you.

Cancer immunotherapies work in several different ways to alert and train a person's immune system to identify and destroy cancer cells. It does this by triggering a stronger than normal immune response.¹

Basically, it trains the immune system to recognize cancer cells and then turns the immune system against the cancer. The idea of harnessing the human immune system to fight cancer dates back more than a century.³

Ideally, immunotherapy will produce a long-lasting population of immune cells that can seek out and eliminate cancer cells.⁴

Chemotherapy works differently. It is a drug that directly attacks fast-growing tumor cells by targeting all rapidly dividing cells inside a person's body. Unfortunately, sometimes healthy cells also get destroyed in the process.¹

Immunotherapy vs. chemotherapy

There are pros and cons to each treatment, and what treatment is right for one person may not be right for another. Here are some differences between immunotherapy and chemotherapy:^1,2

• Treatment timeframes – The treatment length for each therapy is driven by many different factors and is unique to each person and their cancer. However, immunotherapy may continue working even after the treatment period has ended. In contrast, chemotherapy destroys cancer cells only while the drugs are in a person's body.
• Side effects – Immunotherapy can result in an overstimulated immune system. Side effects may be mild, such as skin rashes and diarrhea, or moderate to severe. Because chemotherapy sometimes destroys healthy cells that divide rapidly, such as hair follicles or the gut lining, it can cause unwanted hair loss and nausea.
• Length of time to noticeable results – Effects of immunotherapy may take longer to notice compared to chemotherapy. While chemotherapy can shrink tumors quickly, during the initial stages of immunotherapy tumors may even appear to first grow before shrinking. This seeming growth is likely due to immune cells penetrating the tumor and causing it to appear larger.
• Effectiveness – At least one bladder cancer immunotherapy drug available today helps to prevent bladder cancer from coming back. Seven out of 10 people who receive it also experience remission of their bladder cancer.

Can I use both?

Traditional bladder cancer treatments include various combinations of immunotherapy, chemotherapy, and surgery. Treatment will often depend upon the type of bladder cancer you may have and its location.

But the lines between immunotherapy and chemotherapy are blurring. For example, some of the newer immunotherapies include built-in anti-cancer drugs. Called antibody-drug conjugates, these send targeted antibodies carrying chemotherapy drugs directly to the cancer cells. By delivering toxic drugs straight to the cancer cells, some of the worse side effects of traditional chemotherapy can be lessened.^4,5

Is the future in combination therapies?

Researchers are investigating combination therapies that pair specific immunotherapies with chemotherapy, radiotherapy, and molecular therapy. These are still mostly under investigation in pre-clinical and clinical trials. These are studies where researchers are learning the safest and most effective sequencing of therapies and their doses.⁴

Ask your doctor what treatment may be best for you. It is important to keep in mind that your treatment will be tailored to your specific cancer. Tell us about your experience in the comments below, or share your story with the community.