Bladder cancer

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Immunotherapy for bladder cancer

Immunotherapy is a type of biological therapy that uses the immune system to help destroy cancer cells, and it’s commonly used to treat bladder cancer. Biological therapy uses natural or artificial substances that act like (mimic) or block natural cell responses to kill, control or change the behaviour of cancer cells.

Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of immunotherapy. You may also receive other treatments.

Intravesical immunotherapy

Intravesical immunotherapy is used to treat bladder cancer. Intravesical means the drug is given directly into the bladder.

Immunotherapy may be used after a transurethral resection (TUR) to treat:

  • early stage cancer (Ta, Tis or T1) that is only in the lining of the bladder (called the urothelium)
  • tumours that are large or high grade
  • tumours that come back, or recur, after treatment
  • tumours in more than one place in the bladder (called multifocal tumours)

To lower the risk of side effects, immunotherapy is usually not started until 2 weeks after a TUR.

During intravesical immunotherapy, the doctor passes a tube, or catheter, through the urethra and into the bladder. The drug is given into the bladder through the catheter. The drug is left in the bladder for 1–2 hours to give it time to act on the cancer cells in the lining of the bladder.

The procedure is repeated once a week for 6 weeks. Maintenance therapy is given once a week for 3 weeks at 3, 6, 12, 18, 24, 30 and 36 months.

Drugs used for intravesical immunotherapy

The most common immunotherapy drug used to treat bladder cancer is bacillus Calmette-Guérin (BCG). BCG is the same bacteria used to vaccinate against tuberculosis. It contains live, but weakened, bacteria that stimulate your immune system to kill cancer cells in the bladder.

Interferon alfa (Intron A, Wellferon) is sometimes given with BCG to treat bladder cancer.

Immunotherapy for advanced bladder cancer

Immunotherapy may be offered for locally advanced or metastatic bladder cancer as a second-line therapy if:

  • the cancer is still growing during or just after finishing chemotherapy with cisplatin
  • the cancer recurs within 12 months after finishing chemotherapy with cisplatin

The immunotherapy drugs that may be used for advanced bladder cancer are:

  • pembrolizumab (Keytruda)
  • durvalumab (Imfinzi)
  • avelumab (Bavencio)

Information about specific cancer drugs

Details on specific drugs change quite regularly. Find out more about sources of drug information and where to get details on specific drugs.

Questions to ask about biological therapy

Find out more about biological therapy, including immunotherapy. To make the decisions that are right for you, ask your healthcare team questions about biological therapy.

second-line therapy

Treatment given for a condition or disease (such as cancer) when the first-line therapy (the first or standard treatment) does not work or stops working.

Also called secondary therapy or secondary treatment.


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