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Systemic Chemotherapy

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

Chemotherapy treatment includes powerful medicines that attack actively growing cancer cells in a patient’s body. Chemotherapy is sometimes called “chemo” for short. Chemotherapy drugs work by targeting cells that are multiplying rapidly in the body, such as cancer cells. Cancer cells absorb the chemotherapy medicine and the medicine can then destroy the cancer cells or stop them from multiplying as quickly as they were.1,2

How does a patient receive systemic chemotherapy?

In systemic chemotherapy treatment, patients can receive the chemotherapy medicines by mouth or through an injection. The medicine can be injected into the body through a vein (intravenously, or through an IV) or into a muscle, which is called intramuscular (IM). In bladder cancer, systemic chemotherapy is only given as an injection.1,2

How does chemotherapy work?

Whether the systemic chemotherapy drugs are taken by mouth or injected into a patient’s muscle or vein, the medicine enters the patient’s bloodstream where it is transported all around the body. This means that the chemotherapy medicine can attack bladder cancer cells that have metastasized and have started growing in other parts of the body either nearby the bladder or in more distant parts of the body.1,2

How is systemic chemo different from intravesical chemo?

Although systemic chemotherapy drugs target cancer cells, all of the cells in a patient’s body are exposed to the medicine. In this way, systemic chemotherapy is different than another way that chemotherapy medicine can be delivered, called intravesical chemotherapy. In intravesical chemotherapy for treating early stage or non-muscle-invasive bladder cancer, the medicine is delivered directly into the bladder where it only has an effect on the cancer cells located in the lining of the bladder.1,2

How can chemotherapy be used to treat bladder cancer?

Systemic chemotherapy affects cancer cells located in the bladder as well as in different parts of the body, so it is most often used to treat patients with advanced bladder cancer. Bladder cancer typically starts growing in the thin layer of cells that line the bladder, but it can continue to grow into the muscle of the bladder wall and spread beyond the bladder to other parts of the body.1,2

Chemotherapy to treat advanced bladder cancer

To treat patients with advanced bladder cancer, systemic chemotherapy can be used alone as a main treatment. It is also commonly used in combination with surgery and/or radiation therapy (high-energy X-rays that target areas of the body affected by cancer). When it is combined with radiation therapy, systemic chemotherapy may make the radiation therapy more effective. Combined treatment with radiation therapy and chemotherapy is sometimes referred to as chemoradiation.1,2

What is neoadjuvant therapy?

When systemic chemotherapy is used to treat patients before surgery, it is called neoadjuvant therapy. This therapy is used to help reduce the size of large tumors so that they are easier to surgically remove. It can also help to reduce the chance that the cancer cells will recur, or start to grow again after treatment.1,2

Adjuvant therapy is systemic chemotherapy that a patient receives after having treatment with surgery, or possibly after radiation therapy. This treatment can help to destroy any cancer cells that are remaining after the surgery, or after radiation, and it can help to reduce the chance that the cancer cells will recur.1,2

What medicines are used in systemic chemotherapy?

Patients with bladder cancer commonly receive systemic chemotherapy in cycles lasting a few weeks each. The cycles typically include a treatment period followed by a period without chemotherapy treatment to allow the patient’s body to recover.1,2

There are several different medicines that are used alone or as combinations in systemic chemotherapy treatment for bladder cancer. Drugs that are often used in systemic chemotherapy when combined with radiation therapy include:1,2

  • Cisplatin
  • Cisplatin and fluorouracil (5-FU)
  • Mitomycin and 5-FU

Systemic chemotherapy drugs that may be used when the patient is not also receiving radiation therapy may include the following single drugs and drug combinations:1,2

  • Carboplatin
  • Gemcitabine
  • Cisplatin
  • Docetaxel
  • Paclitaxel
  • Doxorubicin
  • 5-FU
  • Methotrexate
  • Vinblastine
  • Ifosfamide
  • Pemetrexed
  • Gemcitabine and cisplatin (GC)
  • Methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC)
  • Cisplatin, methotrexate, and vinblastine (CMV)
  • Paclitaxel and gemcitabine

Methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) or gemcitabine and cisplatin (GC) are two of the most commonly used systemic treatments. MVAC is now also often done on an accelerated rate called dose-dense MVAC (DD-MVAC).1,2

What are the possible side effects of chemotherapy?

Systemic chemotherapy drugs are very powerful and they can affect cells in the entire body. Chemotherapy drugs can have a negative effect on cells that are healthy but multiply quickly, like the cancer cells that chemotherapy drugs target. This can cause side effects related to bone marrow, hair follicles, the inside of the mouth, and the intestinal lining.1,2

People treated with systemic chemotherapy experience different side effects depending upon their overall health, the type of chemotherapy drug, and how long the treatment lasts. Side effects that are common include:1,2

  • Nausea and vomiting
  • Decreased appetite
  • Hair loss
  • Mouth sores
  • Diarrhea or constipation
  • Increased infection risk
  • Excessive bleeding or bruising
  • Fatigue

While side effects from systemic chemotherapy can be difficult, they tend to go away after the treatment is over. Your healthcare providers will talk with you about what types of side effects that you might experience from chemotherapy and about ways to potentially reduce those effects.

These are not all the possible side effects of systemic chemotherapy. Talk to your doctor about what to expect when receiving systemic chemotherapy. You also should call your doctor if you have any changes that concern you when receiving these drugs.

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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