Medications

Many people with bladder cancer receive medicine as part of their treatment plan. The types of medicines a person may receive depend on the bladder cancer stage and grade, as well as other factors.¹

Drugs that are commonly used for treating bladder cancer include:¹

• Intravesical immunotherapy
• Intravesical chemotherapy
• Systemic chemotherapy
• Systemic immunotherapy drugs
• Targeted therapy drugs

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 those 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 a transurethral resection of bladder tumor (TURBT) procedure to remove tumors from the bladder lining.^1,2

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.^1,2

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 activate and respond to the cancer cells. This means that once the gene therapy is injected, the body’s immune system can target the cancer cells.²

If you have non-muscle invasive bladder cancer (NMIBC) and have not found success with BCG treatment, Anktiva® (nogapendekin alfa inbakicept) is an FDA-approved immunotherapy that might be an option. It helps your immune system recognize and fight off cancer cells, especially when dealing with carcinoma in situ (CIS).⁴

What is intravesical chemotherapy?

Intravesical chemotherapy is another type of medicine that is delivered directly into the bladder through the urethra using a catheter. Chemotherapy includes powerful medicines that attack actively growing cancer cells.^1,2

Intravesical chemotherapy is generally used to treat those with early-stage bladder cancer that is only located in the bladder lining, because it does not affect other cancer cells in the bladder muscle or other parts of the body.^1,2

This type of chemotherapy is also commonly used after 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).^1,2

What is systemic chemotherapy?

Unlike intravesical chemotherapy, which is delivered directly into the bladder, systemic chemotherapy is taken by mouth or injected into the muscle or vein. Systemic chemotherapy drugs enter the bloodstream and can affect all cancer cells in the body, not just those located in the bladder lining.^1,5

Systemic chemotherapy is generally used to treat those with advanced bladder cancer that has spread into the bladder muscle, into organs or tissues near the bladder, or other parts of the body.^1,5

Types of chemotherapy that are used to treat those with advanced bladder cancer include:^1,5

• 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 systemic immunotherapy drugs for bladder cancer?

For people with certain forms of bladder cancer, including some advanced and metastatic bladder cancers, as well as specific other forms of bladder cancer, systemic immunotherapy medicines are a potential treatment option. The exact use of immunotherapy in bladder cancer depends on the medicine being used for treatment.^1,6

These drugs work by affecting the way a person’s own immune system works to help the body attack cancer cells more effectively. Systemic immunotherapy drugs approved for treating those with certain forms of bladder cancer include:^1,6

• Nivolumab (Opdiv®)
• Avelumab (Bavencio®)
• Pembrolizumab (Keytruda®)
• Durvalumab (Imfinzi®)

What are targeted therapy drugs 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 people with certain forms of bladder cancer include:⁷

• Erdafitinib (Balversa®)
• Enfortumab vedotin (Padcev®)

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.