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Female patient speaking to doctor about immunotherapy

Immunotherapy is a type of cancer treatment that uses medications to help the patient’s immune system more effectively destroy cancer cells. Immunotherapy for bladder cancer can be highly effective at reducing recurrence rates as well as improving survival rates and quality of life for patients.

Types of immunotherapy used for bladder cancer

There are two types of immunotherapy that can be effective in combating bladder cancer:

Intravesical immunotherapy

Intravesical therapies are delivered directly into the bladder via a catheter, and they are typically used to treat early-stage non-muscle invasive bladder cancer (NMIBC). One such immunotherapy is Bacillus Calmette-Guerin (BCG) therapy, which is actually a cancer vaccine. It works by teaching the immune system to identify and attack cancer cells in the body. BCG is a type of bacteria that is similar to the kind that causes tuberculosis, and this vaccine is formulated from a weakened strain of the bacteria. It’s typically used after surgical removal of a tumor to prevent recurrence.

Another type of intravesical immunotherapy is nadofaragene firadenovec (Adstiladrin), which is a gene therapy that uses a modified virus to deliver an important immune system protein to the cells that line the bladder wall. This helps the immune system attack cancer cells within the bladder.

Immune checkpoint inhibitors

‘Checkpoints’ refer to proteins located on healthy cells that bind to proteins on T cells (immune cells), which prevents an immune system response. Some cancer cells are able to mimic these checkpoint proteins to avoid the immune system’s attacks. Immune checkpoint inhibitors are medications that prevent the cancer cell proteins from binding with T cell proteins, allowing the immune system to successfully attack bladder cancer cells. 

There are several FDA-approved checkpoint inhibitors for bladder cancer, including:

  • Pembrolizumab (Keytruda®)
  • Atezolizumab (Tecentriq®)
  • Avelumab (Bavencio®)
  • Durvalumab (Imfinzi™)
  • Nivolumab (Opdivo®)

Potential side effects of immunotherapy for bladder cancer

Side effects can vary based on the specific type of immunotherapy. For intravesical therapies, side effects can include:

  • Fever
  • Aches
  • Chills
  • Fatigue
  • Burning feeling in the bladder
  • The need to urinate often
  • Blood in the urine

The side effects of immune checkpoint inhibitors can include:

  • Fatigue
  • Nausea
  • Loss of appetite
  • Fever
  • Urinary tract infections (UTIs)
  • Rash
  • Diarrhea
  • Constipation

Patients who receive immune checkpoint immunotherapies may also experience infusion reactions (which are similar to allergic reactions) or autoimmune reactions, where the immune system starts attacking healthy organs and cells within the body. These types of side effects can be serious if left untreated.

Benefits and effectiveness of immunotherapy for treating bladder cancer

Immunotherapy not only significantly reduces the risk of recurrence for bladder cancer and improves patient survival rates, but it can also be less harsh on the body compared to other cancer treatments, since it uses the patient’s own immune system to attack only cancer cells and leaves healthy cells alone. This means that patients often enjoy better quality of life, both during treatment and beyond. In fact, about 70% of bladder cancer patients go into remission after receiving BCG immunotherapy.

When a physician might recommend immunotherapy for bladder cancer treatment

A physician may recommend different immunotherapies based on the progression of the bladder cancer and each patient’s unique situation. For example, BCG therapy is commonly used to treat early-stage bladder cancer, and Adstiladrin is often used in cases when BSG therapy has not proven effective. 

Immune checkpoint inhibitors may be used for stage 3 or 4 bladder cancer, for cancer that begins growing again after chemotherapy or BCG therapy, for those who cannot receive chemotherapy or for invasive cancer that has been surgically removed but has a high chance of coming back.

Your physician will evaluate your specific type and stage of bladder cancer to determine whether immunotherapy is the best option for you and if so, which type of immunotherapy is indicated.

How immunotherapy compares to other bladder cancer treatment options

Immunotherapy is often used in conjunction with other bladder cancer treatment options. While it works to enhance the immune system’s ability to detect and destroy cancer cells, other treatments work differently:

  • Chemotherapy uses potent chemicals to destroy cancerous cells, though it may damage healthy cells in doing so.
  • Radiation therapy uses powerful X-ray or proton beams that are precisely delivered to the bladder or other areas of the body to kill cancerous cells.
  • Surgery physically removes the tumor or, in more advanced cases, may remove the entire bladder as well cancerous lymph nodes or nearby organs.

Moffitt’s approach to bladder cancer immunotherapy

Moffitt Cancer Center believes in taking a multispecialty approach to the treatment of cancer. The bladder cancer team within our Urologic Oncology Program comprises experts in all specialties, including chemotherapy, radiation therapy, surgery, immunotherapy and more. This ensures that all angles of treatment are considered and that a patient’s individualized treatment plan includes the most appropriate therapies for the best possible outcome and quality of life.

Moffitt is recognized for its groundbreaking research and robust clinical trials program, which includes a range of immunotherapy options for treating bladder cancer. Due to these research efforts alongside our comprehensive treatment and supportive care, we have been recognized as a Comprehensive Cancer Center by the National Cancer Institute—we are the only cancer center based in Florida to hold this designation.

For more information about bladder cancer immunotherapy or to consult with oncologists specializing in the treatment of bladder cancer, call Moffitt at 1-888-663-3488 or complete a new patient registration form online. A referral is not required to make an appointment.


Immunotherapy for Bladder Cancer
Immunotherapy for Bladder Cancer