What is chemotherapy for bladder cancer?

Patients who are diagnosed with metastatic bladder cancer (M stage – M1; cancer which has spread to other parts of the body) are usually treated with chemotherapy. Chemotherapy may also be used in cases of “locally advanced” bladder cancer (T stage – T3 and above and/or N stage – N1 and above) in an attempt to decrease the chances of the cancer coming back after radical cystectomy. This is “adjuvant chemotherapy.” Another strategy entails administering “neoadjuvant chemotherapy” by giving these medications before radical cystectomy in an attempt to improve the results of surgery and decrease the size of the tumor before the operation.

Chemotherapy has the potential to control metastatic bladder cancer and increase the chances of cure when used in a neoadjuvant or adjuvant setting along with surgery. However, chemotherapy has its own set of side effects that some individuals find intolerable.

The time-honored chemotherapy regimen for bladder cancer is the MVAC. It is a combination of four medications given in cyclical form.

Oncologists currently prescribe MVAC in a “dose dense” fashion. This means the patient takes the drugs more frequently than was previously done in the accepted treatment schedule, as well as taking growth factors to help the blood counts to recover faster from the effects of the chemotherapy drugs. The older schedule for MVAC therapy is no longer recommended according to the National Comprehensive Cancer Network.

Some patients with heart disease may not be in a condition to receive Adriamycin and may receive CMV instead (CMV = MVAC without Adriamycin)

An alternative regimen is a combination of gemcitabine (Gemzar) and cisplatin. Physicians use this more often nowadays since some studies have shown that it is equally effective as the MVAC regime with fewer side effects. However, about 40%-50% of patients have medical issues that preclude the use of this therapy.

Cisplatin, which is the main medication in all these regimens, is not given to patients who have an abnormal kidney function. In this case, doctors may substitute it with carboplatin (Paraplatin), which, however, is not as effective as cisplatin-based chemotherapy.

Chemotherapy is an ever-changing method to reduce or eliminate cancer cells; it is best for patients to discuss this therapy with their doctors. Variations in chemotherapy treatments occur among clinicians and one patient’s therapy may be quite different from that of another patient. In addition, health care professionals may introduce newer compounds at any time that may be advantageous to use instead of conventional chemotherapy agents. The following is a list of compounds that some clinicians use to treat various stages of bladder cancer, usually in combination with other anti-cancer cell compounds:

  • Paclitaxel
  • Fluorouracil (5-FU)
  • Gemcitabine
  • Pemetrexed
  • Vinblastine
  • Valrubicin
  • Carboplatin
  • Ifosamide
  • Thioepa
  • Docetaxel

A few cancer treatment centers use, in addition to chemotherapy and endoscopic resection, external radiation beam therapy to treat patients. However, the protocol is complex with toxicity and high pretreatment mortality (death) rates mainly due to sepsis from the chemotherapy. External beam radiation therapy is mainly used in other countries; it is infrequently used in the United States as a primary treatment. Its use to reduce pain from metastases of bladder cancer, especially to the bones, is still of value.

Immunotherapy drugs, such as atzolizumab (Tecentriq) and durvalumab (Imfinzi), also treat bladder cancer. These drugs block a molecule known as PD-L1 that leads to increased immune system (T-cell) activation and decreased tumor size; you should discuss with your doctors what individual treatments are best for your current condition.