Metastatic bladder cancer is sometimes called advanced bladder cancer. When bladder cancer metastasizes, it frequently spreads to the lymph nodes in the pelvis or abdomen, lungs, liver, bones, or other areas of the body. Treatment is usually required if bladder cancer metastasizes.
Advanced (Metastatic) Bladder Cancer Treatment
Treatment For Metastatic Bladder Cancer
Possible treatment options for metastatic bladder cancer include:
Systemic Therapy
Systemic therapy for bladder cancer involves administering drugs that go throughout the body (not directly into the bladder) to target cancer cells. This can include chemotherapy, immunotherapy, and/or targeted therapy. These treatments circulate in the bloodstream to reach cancer cells throughout the body, complementing other local treatments such as surgery or radiation. Their goal is to shrink tumors, prevent cancer from spreading, improve overall survival rates, and hopefully improve symptoms and quality of life.
Chemotherapy
The standard initial (or first line) treatment for metastatic bladder cancer has been chemotherapy, using a combination of anti-cancer drugs including Cisplatin the most common drug used in the treatment of metastatic bladder cancer.
Fifty percent of people with advanced urothelial cancer are not eligible for Cisplatin-based chemotherapy, so alternative treatment options are considered. Carboplatin, a similar drug, is frequently used in such cases.
Immunotherapy
Immunotherapy is a type of cancer treatment that uses the body’s own immune system to fight cancer. It targets and kills cancerous cells, strengthening your body’s immune system in the process. Immunotherapy aims to stop bladder cancer cells from growing and spreading, reducing the risk of cancer coming back. Beyond these critical functions, immunotherapy plays a pivotal role in managing and alleviating symptoms associated with bladder cancer, providing comprehensive support throughout treatment.
Maintenance Therapy
In certain instances, immune checkpoint inhibitors may be given as maintenance therapy after a patient has had chemotherapy. Combining chemotherapy with maintenance immune checkpoint inhibitor treatment can help sustain the benefits of chemotherapy and slow the cancer’s progression.
Targeted Therapy
Targeted therapy for bladder cancer involves targeting certain molecules or pathways that play a pivotal role in the growth and spread of cancer cells. In bladder cancer, one of the main targets for this therapy is the FGFR (Fibroblast Growth Factor Receptor) pathway. FGFRs are proteins found on the surface of some bladder cancer cells that can promote cancer growth when they are overactive/mutated.
Erdafitinib is an example of targeted therapy for bladder cancer. Erdafitinib works by blocking the activity of FGFRs, thus inhibiting the signals that promote cancer cell growth. However, this treatment is only effective for patients whose bladder cancer cells express FGFR which is determined by a special test done by the pathologists.
Antibody-drug conjugates (ADC)
Antibody-drug conjugates, like Enfortumab Vedotin, are tumour targeting antibodies attached to a chemotherapy drug which are administered intravenously. These antibodies work to recognize a specific target expressed on bladder cancer cells. Once that happens, the drug moves into the cancer cells and releases the cancer molecules.
Combination Treatment
Combination treatment for bladder cancer involves using multiple different drugs either together or sequentially to enhance effectiveness. Common combinations include Carboplatin and other types of chemotherapy like gemcitabine, docetaxel, or paclitaxel. These treatments target cancer cells from different angles, potentially improving outcomes. Combination treatment may also be using different types of systemic therapy such as immunotherapy and antibody-drug conjugates such as Pembrolizumab and Enfortumab Vedotin.
Radical Cystectomy
A radical cystectomy is a surgical procedure performed to prevent the spread of cancer by removing the bladder. It may also involve removing lymph nodes and some, or all, of the urethra. Depending on the extent of cancer spread, additional organs may need to be removed as well.
Navigating Bladder Cancer with Bladder Cancer Canada
Bladder Cancer Canada is the first and only patient advocacy organization in Canada dedicated to bladder cancer issues. Facing bladder cancer is undoubtedly a challenging journey, but with the support of the Bladder Cancer Canada community, you can find the strength and knowledge to navigate it more confidently.
Contact us for more information on Advanced or Metastatic Bladder Cancer Treatment.