Intravesical Chemotherapy

Reviewed by: HU Medical Review Board | Last review date: February 2022. | Last updated: March 2022

Chemotherapy is a type of treatment that includes powerful medicines to destroy actively growing cancer cells in the body.1,2 In systemic chemotherapy, the patient receives the medicine by mouth or injected directly into a muscle or a vein (through an IV).

What is intravesical chemotherapy treatment?

In intravesical chemotherapy, the liquid medicine is delivered directly into the patient’s bladder through a catheter. A catheter is a small tube inserted into the bladder through the urethra, the tube-like organ that connects to the bladder so urine can pass out of the body. Systemic chemotherapy affects the entire body, but intravesical chemotherapy directly affects the cells in the lining of the bladder without affecting the entire body.

How is chemo used to treat bladder cancer?

Intravesical chemotherapy is typically used to treat patients with early-stage bladder cancer.1,2 Bladder cancer cells generally start to grow in the urothelium, which is the thin layer of cells that line the inside of the bladder. In early-stage bladder cancer, the cancer cells are only located in the bladder lining and have not grown into the muscle of the bladder wall.

Because it is delivered directly into the bladder, intravesical chemotherapy treatment is only effective against cancer cells located in the bladder lining. This type of treatment does not work against cancer cells that have grown deep into the bladder wall muscle or against cancer cells that are growing outside of the bladder in other organs or tissues.

Treatment after a TURBT

Intravesical chemotherapy is commonly used after a patient with non-muscle-invasive bladder cancer has had a surgical procedure called transurethral resection of bladder tumor (TURBT). During this procedure, the surgeon removes cancer cells from the lining of the bladder using a small, thin instrument inserted into the bladder through the urethra. After the procedure, intravesical chemotherapy may be used to help destroy any remaining cancer cells in the bladder lining and to help potentially reduce the chance of the cancer cells growing back (recurring). Some patients may only receive a single dose of intravesical chemotherapy, while others may need multiple doses.

Which drugs can be delivered directly into the bladder?

Several different drugs can be used in intravesical chemotherapy treatment for early-stage bladder cancer.1 The most commonly used intravesical chemotherapy drug is called mitomycin. Some patients may receive electromotive mitomycin therapy, in which mitomycin is delivered into the bladder through a catheter and while the inside of the bladder is heated. In some cases, this can be more effective than intravesical chemotherapy delivered alone.

Jelmyto (mitomycin gel) is a drug that treats a type of cancer called low-grade upper tract urothelial cancer (LG-UTUC). In this form, mitomycin is given directly into the kidneys by a thin tube (catheter). Jelmyto is liquid when chilled but turns to a gel when inserted into the body. This allows it to coat the hard-to-reach places in the kidney and upper urinary tract.4

Other intravesical chemotherapy drugs include:

  • Gemcitabine
  • Valrubicin

What are the benefits and side effects of chemo?

Chemotherapy medicines that are delivered through intravesical therapy tend to cause fewer side effects than systemic chemotherapy that affects the entire body.1,3 However, intravesical chemotherapy treatment can cause side effects such as bladder irritation or a burning sensation in the bladder. This is not an exhaustive list of all potential side effects of intravesical chemotherapy. Talk to your doctor for further information.

Patients receiving intravesical chemotherapy should talk to their doctor about any other medications (prescription and over-the-counter), herbal remedies, and any supplements they are taking, as well as any other health conditions.

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