Treatments for metastatic bladder cancer

The following are treatment options for metastatic bladder cancer. Metastatic bladder cancer has spread to other parts of the body. This includes stage 4 and bladder cancers that come back in another part of the body (called distant recurrences). Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Chemotherapy is usually offered for metastatic bladder cancer. It is usually the first treatment to help slow the growth and spread of the cancer. It is used to help improve survival and quality of life.

Chemotherapy is given as a systemic therapy. A combination of chemotherapy drugs that includes cisplatin is commonly used. Other single drugs or combinations may be used if cisplatin-based chemotherapy causes too many side effects

Targeted therapy is sometimes used to treat metastatic bladder cancer. Targeted therapy uses drugs to target specific molecules (such as proteins) on or inside cancer cells to stop the growth and spread of cancer and limit harm to normal cells. Erdafitinib (Balversa) can be used to treat metastatic bladder cancer that has mutations in the FGFR2 or FGFR3 gene and doesn't respond to chemotherapy.

You may be offered external radiation therapy for metastatic bladder cancer. It may be used if surgery can’t be done (the cancer is unresectable) or to control bleeding or pain from the bladder.

If bladder cancer spreads to the bone, external radiation therapy is sometimes used to treat it. Find out more about bone metastases.

Immunotherapy helps to strengthen or restore the immune system's ability to fight cancer. You may be offered immunotherapy for metastatic bladder cancer. An immune checkpoint inhibitor may be offered for advanced or metastatic bladder cancer that:

• is still growing during or after chemotherapy that includes the drug cisplatin
• comes back within 12 months of finishing chemotherapy
• can't be treated with chemotherapy

An immune checkpoint inhibitor is most often used alone, but may be combined with chemotherapy. It can be used as a maintenance therapy after chemotherapy.

The immune checkpoint inhibitors used for metastatic bladder cancer are:

• pembrolizumab (Keytruda)
• nivolumab (Opdivo)
• durvalumab (Imfinzi)
• avelumab (Bavencio)

Enfortumab vedotin (Padcev) is a monoclonal antibody that is used to treat metastatic bladder cancer. You may be offered enfortumab vedotin if you have been treated with the chemotherapy drugs cisplatin or carboplatin and an immune checkpoint inhibitor. Enfortumab vedotin may also be combined with pembrolizumab.

Surgery may be offered for some cases of metastatic bladder cancer if surgery is possible (the cancer is resectable). It is used to help control symptoms, such as bleeding and pain (called palliative surgery). The type of surgery done depends on how the symptoms can be managed. Types of surgery that may be done include the following.

A transurethral resection of bladder tumour (TURBT) to remove tumours from the bladder through the urethra.

A cystectomy to remove all or part of the bladder. It is not a common surgery for metastatic bladder cancer.

A urinary diversion to make a new way to hold urine (pee) and pass it out of the body. It is done after the whole bladder is removed (radical cystectomy). A urinary diversion (without a cystectomy) may also be done if there is a blockage and urine can’t leave the body.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Talk to your doctor about clinical trials open to people with bladder cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.