Bladder Cancer: Immunotherapy 

What is immunotherapy?

Immunotherapy helps the immune system fight cancer. This type of treatment is sometimes called biological therapy. For this treatment, medicines are used to make the body’s own immune system attack and kill cancer cells.

When might immunotherapy be used for bladder cancer?

Your healthcare provider may suggest intravesical immunotherapy if you have early-stage, superficial bladder cancer. This means the cancer is small and has not spread beyond the lining of your bladder. Immunotherapy may be used to kill cancer cells without having to remove the bladder. It can also help keep cancer from coming back after treatment.

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?


Intravesical chemo

The most common way to give this treatment for bladder cancer is intravesically. This means the medicines are put right into your bladder instead of injected into your blood. Early-stage bladder cancer can often be treated with the immunotherapy medicine called Bacillus Calmette-Guerin (BCG). BCG is put into your bladder through a catheter in your urethra. Your body’s immune system responds to BCG and is "turned on" to attack and kill the bladder cancer cells.

You go to your provider’s office or an outpatient clinic to have this done. For 4 hours before the treatment, you should not drink any liquids. Your bladder needs to be empty for BCG to work.

A soft thin catheter is put through your urethra into your bladder. This isn’t painful. But you’ll feel some discomfort when the catheter goes through your urethra. Any urine left in your bladder drains out through the catheter. Then the BCG is put through the catheter and into your bladder.

Sometimes the catheter is left in place. Then the BCG is drained out through it when treatment is over. In some cases, the catheter is removed after the BCG has been put into your bladder. Then you should do your best not to urinate for at least 2 hours. This lets the medicine to stay in your bladder long enough to activate your immune system to kill cancer cells. You’ll lie flat while the medicine is in your bladder. You’ll be asked to change position from time to time to make sure the medicine reaches all parts of the bladder lining.

Because BCG is made up of live bacteria, it’s important to follow instructions about handling your urine after treatment. Wash your hands after urinating. You may be told to add bleach to the toilet water for the first few hours after the treatment to kill the bacteria in your urine. 

You'll be told to drink a lot of water starting about 2 hours after the treatment. This will dilute the BCG that's left in your bladder. It will also help reduce bladder irritation, fever, and other side effects.

Most people have 6 weekly treatments at first. Follow-up treatment will be done over the next 12 to 24 months. Follow-up treatments may be given once a month or less often. For instance, you may get a treatment once every 3 months. These treatments are called maintenance BCG treatments. They help keep the cancer from coming back.

Systemic immunotherapy

This means the immunotherapy medicine is given into your blood by IV (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.

Systemic immunotherapy is used to treat a lot of different cancers, but is fairly new as a bladder cancer treatment. A lot of research is being done on this. Some of the immunotherapy medicines now used for bladder cancer are:

  • Atezolizumab
  • Durvalumab
  • Avelumab
  • Nivolumab
  • Pembrolizumab

These medicines target a protein that keeps immune system cells from killing cancer cells. When this protein is blocked, your immune system is able to stop tumor growth, make tumors grow slower, or kill cancer cells.

Systemic immunotherapy is usually given every 2 or 3 weeks. 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.

Side effects of intravesical immunotherapy can include:

  • Discomfort or burning in your bladder

  • Feeling the need to urinate often

  • Pain when you urinate
  • Blood or clots in your urine
  • Flu-like symptoms, such as chills, fatigue, or fever

  • Serious infection if BCG spreads through your body (This is rare.)

These side effects often go away within a few days after the 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, like itchy rashes, redness, blistering, cracking, and dryness
  • Inflammation around finger and toe nails
  • Fatigue
  • Cough
  • Appetite loss
  • Nausea

Most of these side effects can be treated, and some can even be prevented. Talk to your treatment team to learn what you can do to help manage side effects. Be sure you know when you need to let your healthcare provider know about side effects. 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 example, it's normal to have a slight fever after immunotherapy. But if you have a lingering fever of 101.5°F (38.6°C) or higher, or other symptoms that last for more than 2 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 and weekends?

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.

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