Bladder Cancer: Immunotherapy
What is immunotherapy?
Immunotherapy helps your own immune system better fight cancer. This type of treatment is sometimes
called biologic therapy. For this treatment, medicines are used to make the immune
system find and kill cancer cells.
When might immunotherapy be used for bladder cancer?
Immunotherapy might be an option if:
You have early-stage, superficial bladder cancer. This means the cancer is small and
has not spread beyond the lining of your bladder. (This is the most common use for
Cancer does not respond to or starts growing again after chemotherapy.
You have health problems that keep you from getting chemotherapy.
Systemic immunotherapy might be used for bladder cancer that has spread to other parts of the body or has
come back after treatment.
How is immunotherapy given for bladder cancer?
These are the 2 ways immunotherapy might be given:
The most common way to give immunotherapy for bladder cancer is intravesically. This
means the medicines are put right into your bladder. (They don't go to the rest of
Early-stage bladder cancer are often treated with immunotherapy. These cancers are
small and only in the lining of your bladder. They have not spread into deeper layers
of the bladder wall. The medicine used is called BCG (Bacillus Calmette-Guerin). It's
put into your bladder through a catheter that's put in through your urethra. Your
body’s immune system responds to BCG and is "turned on" to attack and kill the bladder
BCG treatment can be done in your provider’s office or an outpatient clinic. You will
go home the same day. Most people get weekly treatments for 6 weeks at first. This
can be repeated if needed. Then follow-up treatments will be done over the next 1
to 3 years. Follow-up treatment schedules vary a lot. For instance, you may get a
treatment 3 weeks in a row every 3 months or it might be done twice a year. These
treatments are called maintenance BCG treatments. They help keep the cancer from coming
back. Your healthcare provider will talk with you about the best plan based on your
cancer and how it responds to treatment.
This means the immunotherapy medicine is put into your blood through a vein (by IV
or intravenously). The medicine can then go through your whole body. This is why it's
used to treat cancer that has spread beyond the bladder.
Some of the immunotherapy medicines used for bladder cancer include:
These medicines target certain proteins that keep immune system cells from killing
cancer cells. When these proteins are blocked, your immune system is able to stop
tumor growth, make tumors grow at a slower rate, or kill cancer cells.
Systemic immunotherapy is often given once a week every few weeks. The schedule depends
on the medicine that's used. You can get it at your provider's office or an outpatient
clinic. You don't have to stay in the hospital for this treatment.
What are common side effects of immunotherapy?
Side effects depend on the way you get immunotherapy and the medicine that's used.
Side effects of intravesical immunotherapy can include:
Mild pain or burning in your bladder
Feeling the need to urinate often
Pain when you urinate
Bloody urine, or even blood clots in your urine
Flu-like symptoms, such as chills, severe tiredness (fatigue), achiness, and fever
Serious infection if BCG spreads through your body. (This is rare, but can happen
even many years later.)
These side effects often go away a few days after treatment. Still, make sure you
know what to watch for and when you need to contact your doctor.
Side effects of systemic immunotherapy can include:
Skin changes, such as itchy rashes, redness, blistering, cracking, and dryness
Redness and swelling (inflammation) around fingernails and toenails
Urinary tract infections (UTIs)
Most of these side effects can be treated, and some can even be prevented. Talk with
your treatment team to learn what you can do to help manage side effects. Be sure
you know what side effects your healthcare provider needs to know about right away.
Most of them go away after treatment ends, but some can become long-term problems.
Working with your healthcare provider
Talk with your healthcare providers about what side effects to look for and when to
call them. For instance, it's normal to have a slight fever after immunotherapy. But
if you have a high fever or other symptoms that last for more than a few days, call
your healthcare provider. It could be a sign of infection. Make sure you know what
number to call with questions or problems. Is there a different number for evenings,
weekends, or holidays?
It may be helpful to keep a diary of your side effects. Write down physical, thinking,
and emotional changes. A written list will make it easier for you to remember your
questions when you go to your appointments. It will also make it easier for you to
work with your healthcare team to make a plan to manage your side effects.