What is systemic chemotherapy?
Chemotherapy treatment includes powerful medicines that attack actively growing cancer cells in a patient’s body.1,2 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.
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.
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.
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.
How can it 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 is most often used to treat patients with advanced bladder cancer.1,2 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.
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.
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. 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.
What medicines are used in systemic chemotherapy?
Patients with bladder cancer commonly receive systemic chemotherapy in cycles lasting a few weeks each.1 The cycles include a treatment period followed by a period without chemotherapy treatment to allow the patient’s body to recover. 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:
- 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:
- Gemcitabine and cisplatin
- Methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC)
- Cisplatin, methotrexate, and vinblastine (CMV)
- Carboplatin and either paclitaxel or docetaxel
Methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) or gemcitabine and cisplatin (GC) are the two most commonly used systemic treatments. MVAC is now also often done on an accelerated rate called dose-dense MVAC (DD-MVAC).
What are the possible side effects?
Systemic chemotherapy drugs are very powerful and they can affect cells in the entire body.1 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.
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:
- Nausea and vomiting
- Decreased appetite
- Hair loss
- Mouth sores
- Diarrhea or constipation
- Increased infection risk
- Excessive bleeding or bruising
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.
- Chemotherapy for Bladder Cancer. American Cancer Society. https://www.cancer.org/cancer/bladder-cancer/treating/chemotherapy.html. Accessed September 2017.
- Bladder Cancer. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/facts-about-bladder-cancer. Accessed September 2017.