What Is Maintenance Therapy?

Reviewed by: HU Medical Review Board | Last reviewed: April 2023

Maintenance therapy may be recommended for some patients who have been diagnosed with bladder cancer and have already completed their initial treatment.1 In non-muscle-invasive bladder cancer, the cancer cells are only located in the urothelium, which is the thin layer of cells that line the inside of the bladder. The cancer cells have not grown into the muscle of the bladder wall.

Why do some people have maintenance therapy?

Healthcare providers may advise patients who have certain types of non-muscle invasive bladder cancer to have maintenance therapy to attempt to keep the bladder cancer cells from growing back after treatment, which is called recurrence. Maintenance therapy may be recommended for patients who have a type of bladder cancer that is linked to a higher risk of recurrence.

Bladder cancer recurrence

Recurrence is not uncommon among patients who have been treated for non-muscle-invasive bladder cancer. Because treatment tends to be more effective when recurrence is detected early, healthcare providers will monitor patients regularly after treatment to check for signs that the cancer cells have started growing again. Maintenance therapy may also be used to potentially help reduce the risk that the bladder cancer will recur, or start growing again after the initial treatment is finished.

What is BCG?

Maintenance therapy for bladder cancer typically involves a type of treatment called Bacillus Calmette-Guerin (BCG) intravesical immunotherapy.2,3 BCG is a type of bacteria that helps the immune system to destroy cancer cells located in the bladder lining. It works by causing a reaction in a patient’s immune system that activates immune system cells and causes them to attack cancer cells that are growing in the lining of the bladder.

What is BCG maintenance therapy?

BCG maintenance therapy is an intravesical treatment, which means that it is delivered directly into the bladder. BCG treatment in bladder cancer is known as local immunotherapy. BCG is a liquid medicine that is administered through a catheter, which is a thin, flexible tube that is inserted into the bladder through the urethra, a tube that allows urine to flow out of the body from the bladder. The medicine is then held in the patient’s bladder for a specified amount of time before the patient urinates.

In addition to being used for bladder cancer maintenance therapy, BCG treatment can also be used as part of the initial treatment for certain types of early-stage non-muscle-invasive bladder cancer.

How long does it last?

The aim of maintenance therapy is to try to reduce the risk of bladder cancer recurrence as much as possible.2,3 The length of a patient’s maintenance therapy with BCG immunotherapy depends on multiple factors, such as the grade of the patient’s cancer, and the judgment of the healthcare providers on the cancer care team.

Maintaining a regular treatment schedule

An example of a maintenance therapy treatment regimen is BCG immunotherapy delivered once per week for three weeks in a row. Some patients may be advised to receive this three-week round of treatment every three to six months for one year. Other patients may be advised to continue receiving maintenance therapy for longer than one year, with an example treatment regimen schedule of once per week for three weeks, and 3 to 6 months between treatments.

For maintenance therapy to be as effective as possible, it is important to maintain the regular treatment schedule, as directed by your healthcare professional, without delays or skipping treatments.

BCG side effects

It is not uncommon for patients who receive maintenance therapy with BCG immunotherapy to experience side effects.2,4 These tend to occur more often after a patient has already received at least three previous treatments.

Common side effects caused by BCG immunotherapy include:

This is not a complete list of all possible side effects from BCG.

Talk to your doctor

Let your healthcare provider know if you experience any symptoms or side effects from BCG immunotherapy. If you experience a high fever, let your healthcare provider know right away. In rare cases, BCG treatment can cause serious infections that need to be treated immediately.

Before beginning treatment for bladder cancer, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.

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