Chemotherapy is a potent drug treatment that targets fast-growing cancer cells in the body. It can be administered as an infusion or injection, with drugs delivered through a catheter into a vein, artery, body cavity, or part of the body.
Chemotherapy and Radiation Treatment for Bladder Cancer
Chemotherapy for Bladder Cancer
Drugs Used for Chemotherapy
Chemo drugs may be used alone or in combination, depending on what they are being used for, a person’s overall health, and other factors.
When chemo is given with radiation, the most common drugs used include:
- Cisplatin
- Cisplatin plus fluorouracil (5-FU)
- Mitomycin with 5-FU
When chemo is used without radiation, the most common combinations include:
- Gemcitabine and cisplatin
- Dose-dense methotrexate, vinblastine, doxorubicin (Adriamycin), and cisplatin (DDMVAC)
- Cisplatin, methotrexate, and vinblastine (CMV)
- Gemcitabine and paclitaxel
For some people, the side effects of getting more than one chemo drug might be too much to handle. For those people, treatment with a single drug, such as gemcitabine or cisplatin, may be an option.
Other chemo drugs sometimes used to treat bladder cancer include, docetaxel, ifosfamide, and pemetrexed.
What is neoadjuvant chemotherapy?
Neoadjuvant chemotherapy is administered before surgery and has been shown in clinical trials to improve survival for patients with invasive bladder cancer undergoing radical cystectomy. This type of chemotherapy aims to shrink the bladder tumor and may also eliminate small metastatic deposits of disease that have spread beyond the bladder.
Using a single chemotherapy drug does not seem to improve survival for patients with locally advanced bladder cancer. Neoadjuvant treatment typically follows a specific treatment plan, or regimen, specifying dosage, schedule, and duration of treatment. The two recommended regimens for neoadjuvant treatment are either dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) or gemcitabine and cisplatin (GC).
What is adjuvant chemotherapy?
Adjuvant chemotherapy is administered after bladder removal surgery, which often includes removing nearby lymph nodes for analysis. If the pathology results reveal cancer spread to the lymph nodes, adjuvant chemotherapy may be recommended to prevent cancer recurrence by targeting any microscopic cancer cells that were not visible during surgery. Typically, Dose Dense MVAC or GC regimens are suggested in this scenario. If bladder cancer has spread beyond the bladder, systemic chemotherapy is advised. While metastatic bladder cancer is challenging to cure, treatment aims to slow cancer spread, alleviate symptoms, and prolong life.
Chemotherapy can affect healthy cells in the body, leading to various side effects. It’s essential to discuss potential side effects of different chemotherapy regimens with your medical team, who can help manage these effects.
Intravesical vs Intravenous Chemotherapy
Intravesical Chemotherapy:
- Delivers chemotherapy drugs directly into the bladder through a catheter.
- Most often used for non-muscle invasive bladder cancer.
- Often administered after TURBT to help prevent a recurrence.
- Drugs may include Mitomycin-C or gemcitabine.
Intravenous Chemotherapy:
- Delivers chemotherapy drugs through a vein, allowing them to circulate throughout the body via the bloodstream.
- Most often used for muscle invasive bladder cancer.
- Aimed at treating cancer cells that may have spread beyond the bladder.
- Drugs may include cisplatin, gemcitabine, paclitaxel, or carboplatin, either alone or in combination.
Side Effects of Chemotherapy
Some chemotherapy side effects are mild and treatable, while others can cause serious complications. Tiredness (fatigue) is one of the most common side effects of chemotherapy. Many people having treatment feel tired a lot of the time or get tired very easily doing everyday tasks.
Other common side effects of chemotherapy drugs include:
- Nausea
- Vomiting
- Diarrhea
- Hair loss
- Loss of appetite
- Fatigue
- Fever
- Mouth sores
- Pain
- Constipation
- Easy bruising
- Bleeding
Many of these side effects can be prevented or treated. Most side effects subside after treatment ends.
Radiation Therapy for Bladder Cancer
Radiation therapy is not universally recommended for all bladder cancer patients. While it may be considered for non-muscle invasive bladder cancer cases that are BCG-unresponsive, its primary use is typically reserved for muscle invasive or metastatic bladder cancer. In these cases, radiation is used to treat symptoms and improve cancer side effects.
Likely candidates for radiation therapy should have:
- Good bladder function
- Small and/or single tumors
- Absence of CIS (carcinoma in situ)
- No severe kidney blockage
- A tolerance of adjunctive treatments like chemotherapy or carbogen gas during radiation
- Commitment to regular follow-ups (cystoscopy)
Combining Chemotherapy and Radiation
In recent years, the combination of chemotherapy and radiation has emerged as a bladder preservation therapy for high-risk cases, particularly those involving muscle invasion. Previously, radiation therapy alone was used effectively to shrink tumors. However, since bladder cancer cells are sensitive to chemotherapy and responsive to anticancer drugs, the addition of combined chemotherapy (multiple drugs given together) to radiation has led to improved outcomes.
For bladder preservation therapy to succeed, several requirements must be met, including:
- Transurethral resection of the tumor (TURBT),
- No obstruction of one or both kidneys due to the bladder tumor,
- The absence of T4 bladder tumors.
If tumors do not respond to initial chemotherapy and radiation, a cystectomy (surgical removal of the bladder) may be considered if medically feasible.
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.
For more information on bladder preservation therapy, click here.