Bladder cancer medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Steven C. Campbell, M.D., Ph.D. Associate Editor(s)-in-Chief:  Farima Kahe M.D. [2]

## Overview

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The predominant therapy for bladder cancer is surgical resection. Adjunctive chemotherapy, radiation therapy, and immunotherapy may be required.

## Medical Therapy

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Immunotherapy

* Immunotherapy is a type of biological therapy that uses the immune system to help destroy cancer cells.[1]
* Bacillus Calmette–Guérin (BCG)

* Immunotherapy by intravesicular delivery of Bacillus Calmette–Guérin (BCG) is often used to treat and prevent the recurrence of superficial tumors.[2]
* BCG is a vaccine against tuberculosis that is prepared from attenuated live Mycobacterium bovis, that has lost its virulence in humans. BCG immunotherapy is effective in up to 2/3 of the cases at this stage, and in randomized trials has been shown to be superior to standard chemotherapy.[3]
* The mechanism by which BCG prevents recurrence is unknown, but the presence of bacteria in the bladder may trigger a localized immune reaction which clears residual cancer cells.

Chemotherapy

* Intravesical chemotherapy

* During intravesical chemotherapy, the drugs are placed into the bladder through a urinary catheter.[4][5]
* Intravesical chemotherapy may be given instead of BCG or if the bladder cancer doesn’t respond to BCG.[6]
* Mitomycin is the drug most often used in intravesical chemotherapy.[7][8]

* Systemic chemotherapy

* During systemic chemotherapy, the drugs are given intravenously.
* Systemic chemotherapy may be a treatment option for bladder cancer that has spread to other tissues near the bladder and bladder cancer that has spread to other parts of the body.[9]
* Chemotherapy is recommended before a radical cystectomy (called neoadjuvant chemotherapy) for many people with bladder cancer that has grown into the muscle layer of the bladder wall. It is also often given after a radical cystectomy (called adjuvant chemotherapy) to people with high-risk features such as cancer that has spread to lymph nodes.[10]

Radiation therapy

* Radiation therapy may be the main treatment for people who can’t have surgery.[11]

* External beam radiation therapy is the type of radiation treatment that is most often used to treat bladder cancer.[12]

* Palliative radiation therapy may be given to relieve symptoms caused by advanced bladder cancer.[13]

## References

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1. ↑ Ghahestani SM, Shakhssalim N (2009). "Palliative treatment of intractable hematuria in context of advanced bladder cancer: a systematic review". Urol J. 6 (3): 149–56. PMID 19711266.
2. ↑ Alexandroff AB, Jackson AM, O'Donnell MA, James K (May 1999). "BCG immunotherapy of bladder cancer: 20 years on". Lancet. 353 (9165): 1689–94. doi:10.1016/S0140-6736(98)07422-4. PMID 10335805.CS1 maint: Multiple names: authors list (link)
3. ↑ Lamm, Donald L.; Blumenstein, Brent A.; Crawford, E. David; Montie, James E.; Scardino, Peter; Grossman, H. Barton; Stanisic, Thomas H.; Smith Jr, Joseph A.; Sullivan, Jerry; Sarosdy, Michael F.; Crissman, John D.; Coltman, Charles A. (1991). "A Randomized Trial of Intravesical Doxorubicin and Immunotherapy with Bacille Calmette–Guérin for Transitional-Cell Carcinoma of the Bladder". New England Journal of Medicine. 325 (17): 1205–9. doi:10.1056/NEJM199110243251703. PMC 1164610. PMID 1922207.
4. ↑ Bladder Cancer. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/bladder/treatment/?region=ab Accessed on October, 7 2015
5. ↑ Porten SP, Leapman MS, Greene KL (2015). "Intravesical chemotherapy in non-muscle-invasive bladder cancer". Indian J Urol. 31 (4): 297–303. doi:10.4103/0970-1591.166446. PMC 4626913. PMID 26604440.
6. ↑ Shen Z, Shen T, Wientjes MG, O'Donnell MA, Au JL (July 2008). "Intravesical treatments of bladder cancer: review". Pharm. Res. 25 (7): 1500–10. doi:10.1007/s11095-008-9566-7. PMC 2440939. PMID 18369709.
7. ↑ Volpe A, Racioppi M, D'Agostino D, Cappa E, Filianoti A, Bassi PF (June 2010). "Mitomycin C for the treatment of bladder cancer". Minerva Urol Nefrol. 62 (2): 133–44. PMID 20562793.
8. ↑ Williams SK, Hoenig DM, Ghavamian R, Soloway M (April 2010). "Intravesical therapy for bladder cancer". Expert Opin Pharmacother. 11 (6): 947–58. doi:10.1517/14656561003657145. PMID 20205607.
9. ↑ Rose TL, Milowsky MI (May 2016). "Improving Systemic Chemotherapy for Bladder Cancer". Curr Oncol Rep. 18 (5): 27. doi:10.1007/s11912-016-0512-2. PMID 26984414.
10. ↑ Teply BA, Kim JJ (2014). "Systemic therapy for bladder cancer - a medical oncologist's perspective". J Solid Tumors. 4 (2): 25–35. doi:10.5430/jst.v4n2p25. PMC 4232954. PMID 25404954.
11. ↑ Konski A, Feigenberg S, Chow E (April 2005). "Palliative radiation therapy". Semin. Oncol. 32 (2): 156–64. PMID 15815960.
12. ↑ Kaufman DS, Shipley WU, Althausen AF (February 1992). "Radiotherapy and chemotherapy in invasive bladder cancer with potential bladder sparing". Hematol. Oncol. Clin. North Am. 6 (1): 179–94. PMID 1556049.
13. ↑ Byun SJ, Kim JH, Oh YK, Kim BH (December 2015). "Concurrent chemoradiotherapy improves survival outcome in muscle-invasive bladder cancer". Radiat Oncol J. 33 (4): 294–300. doi:10.3857/roj.2015.33.4.294. PMC 4707212. PMID 26756029.

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