Urothelial cancer (also called transitional cell carcinoma) is the most common type of bladder cancer. The standard initial (or first-line) treatment for metastatic urothelial cancer is chemotherapy, using a combination of anti-cancer drugs based on Cisplatin, the most common drug used in the treatment of metastatic bladder cancer.

Cisplatin is a platinum-based drug that kills cancer cells by damaging their DNA and stopping them from dividing. Depending on the dosage, Cisplatin can affect the nerves, inner ear and kidneys.

You’re eligible for this type of chemotherapy if you’re medically fit. Being considered medically fit involves assessment of various factors, including:

·      Kidney function

·      Heart function

·      Performance status (a score that estimates your ability to perform certain activities of daily living without the help of others)

·      Hearing capacity

·      Existing peripheral neuropathy (peripheral neuropathy is a type of nerve damage that usually causes pain, numbness or tingling in the fingers and toes, but can progress up the limbs to involve the feet and legs, hands and arms)

·      Other factors your medical team may consider important

Fifty percent of people with advanced urothelial cancer are not eligible for Cisplatin-based chemotherapy, so alternative treatment options are considered.

These can include combinations using Carboplatin, or nonplatinum-based drugs, such as gemcitabine, docetaxel or paclitaxel. In patients who are not eligible for Cisplatin, immunotherapy may be beneficial, but this requires further study and is not yet approved in this setting in Canada.