Medications

Many patients with bladder cancer receive medication as part of their treatment plan. The types of medicines a patient may receive depends on the patient’s bladder cancer stage and grade, as well as other factors.

Drugs that are commonly used for treating bladder cancer

• Intravesical immunotherapy
• Intravesical chemotherapy
• Systemic chemotherapy
• Immunotherapy medicines
• Targeted therapy

What is intravesical immunotherapy?

Bacillus Calmette-Guerin (BCG) vaccine treatment is a type of intravesical (delivered directly into the bladder) immunotherapy that can be used to treat patients who have early-stage bladder cancer that is only located in the lining of the bladder, but has not grown into the muscle of the bladder wall. It is often used after patients have a transurethral resection of bladder tumor (TURBT) surgical procedure to remove tumors from the bladder lining.¹

BCG immunotherapy is delivered directly into the bladder through the urethra, using a catheter. BCG is a type of bacteria that attracts the body’s immune system cells and causes them to attack cancer cells in the bladder lining.¹

Adstiladrin® (nadofaragene firadenovec-vncg) is a type of gene therapy approved to treat adults with certain forms of high-risk non-muscle invasive bladder cancer that is not responsive to BCG therapy. The drug is injected into the bladder, where it latches onto cells. Then, it uses a carrier virus called an adenovirus to introduce the gene into the cells.^2,3

Once the gene is inside the bladder cells, the cells start making a protein called interferon alfa-2b. This protein then signals the immune system to target the cancer cells. This means that once the gene therapy is injected, the body’s immune system can get rid of the cancer cells.^2,3

What is intravesical chemotherapy?

Intravesical chemotherapy is another type of medicine that is delivered directly into the patient’s bladder through the urethra using a catheter. Chemotherapy includes powerful medicines that attack actively growing cancer cells. Intravesical chemotherapy is generally used to treat patients with early-stage bladder cancer that is only located in the bladder lining, because it does not have an effect on other cancer cells in the bladder muscle or in other parts of the body.⁴

This type of chemotherapy is also commonly used in patients after they have TURBT surgery to help destroy any cancer cells remaining in the bladder lining, as well as helping to prevent cancer cells from recurring (growing back after treatment).⁴

What is systemic chemotherapy?

Unlike intravesical chemotherapy, which is delivered directly into the patient’s bladder, systemic chemotherapy is taken by mouth or injected into the patient’s muscle or vein. Systemic chemotherapy drugs enter the blood stream and can affect all cancer cells in the body, not just those located in the bladder lining. Systemic chemotherapy is generally used to treat patients with advanced bladder cancer that has spread into the bladder muscle, into organs or tissues near the bladder, or into other parts of the body.⁵

Types of chemotherapy that are used to treat patients with advanced bladder cancer include:⁵

• Neoadjuvant chemotherapy (before surgery)
• Adjuvant chemotherapy (after surgery)
• Chemoradiation therapy (systemic chemotherapy combined with radiation therapy)
• Chemotherapy may also be used alone as a single treatment option

What are immunotherapy medicines for bladder cancer?

For patients with certain forms of bladder cancer, including some advanced and metastatic bladder cancers, as well as specific other forms of bladder cancer, immunotherapy medicines are a potential treatment option. The exact use of immunotherapy in bladder cancer depends on the individual medication being utilized for treatment.⁶

These drugs work by affecting the way a patient’s own immune system works to help the patient’s body attack cancer cells more effectively. Immunotherapy drugs approved for treating patients with certain forms of bladder cancer include:⁶

• Nivolumab (brand name: Opdivo)
• Avelumab (brand name: Bavencio)
• Pembrolizumab (brand name: Keytruda)

What are targeted therapy medicines for bladder cancer?

Certain changes happen inside cells that cause cancer, and targeted therapies are medications that target these specific changes. They are different from standard chemotherapy in this way; they are more specific and can therefore work in a different, more focused way, providing treatment for cancer while attempting to minimize damage to healthy cells.⁷

Targeted therapies approved for treating patients with certain forms of bladder cancer include:⁷

• Erdafitinib (brand name: Balversa)
• Enfortumab vedotin (brand name: Padcev)
• Sacituzumab govitecan (brand name: Trodelvy)

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.