What is the treatment for metastatic urothelial bladder cancer?

Urothelial carcinoma (UC) is a type of cancer that begins in cells called urothelial cells. It is also known as transitional cell carcinoma.

Urothelial cells make up the inner lining of organs and structures in the urinary tract (the urothelium). Most cases of UC begin in the bladder, and the majority of bladder cancers are UC. Though it’s less common, UC can also begin in the kidneys and the tubes that connect the kidneys and bladder (the ureters).

Metastatic urothelial bladder cancer is an advanced urothelial carcinoma that began in the bladder but has spread to distant sites in the body, such as lymph nodes, lungs, or bones. Metastatic urothelial bladder cancer is stage IV cancer.

Treatment for metastatic urothelial bladder cancer is different for everyone. While stage and spread are major factors that are considered when making treatment decisions about metastatic urothelial cancer, there are other important pieces of information that will factor into the decision-making process. These include:

• The size and exact location of the tumor or tumors
• The grade of the cancer (how abnormal the cancer cells look compared to healthy urothelial cells)
• The age and overall health of the person being treated
• The risk of treatment side effects
• The priorities and preferences of the person being treated

What are the main treatments for metastatic bladder UC?

In general terms, cancer treatments can be thought of in two ways—localized therapies that target specific tumors, and systemic therapies that act on cancer cells throughout the body. Systemic therapies are the main treatment approach for metastatic urothelial bladder cancer and can include:

• Immune checkpoint inhibitors. A type of immunotherapy that works by blocking immune checkpoints, proteins that prevent the immune system from attacking cancer cells. Blocking immune checkpoints helps the immune system identify and destroy cancer cells.
• Chemotherapy. Drugs that contain substances that kill cancer cells or stop cancer cells from dividing.
• Targeted therapy drugs. Drugs that target specific molecules or processes that cancer cells need to grow and spread. For urothelial bladder cancer, targeted therapy drugs are typically used if other treatments do not work.
• Antibody-drug conjugates (ADCs). These drugs are lab-produced antibodies, proteins that attach to harmful substances in the body. They contain a chemotherapy drug but target cancer cells with much greater precision than traditional chemotherapy, helping to avoid damage to healthy tissue. ADCs are part immunotherapy, part chemotherapy, and part targeted therapy.

Different types of therapies and different drugs can be used in combination with one another or on their own. For example:

• An immune checkpoint inhibitor plus an antibody drug conjugate
• An immunotherapy plus chemotherapy
• One or several chemotherapy drugs
• Chemotherapy followed by immunotherapy
• Immunotherapy used on its own

Different drugs and combinations of drugs may be recommended to treat a cancer that hasn’t responded to an initial therapy.

Is surgery or radiation used to treat advanced bladder cancer?

Treatment for metastatic urothelial bladder cancer can be a multistep process. Following initial treatment with systemic therapies, a person can expect tests and exams that check how the cancer responded to treatment. Based on the results of those tests, a healthcare team will recommend the next steps.

In some cases, the next steps may involve surgery to remove the bladder, or chemotherapy used in combination with radiation therapy. Radiation therapy uses high-energy radiation to shrink or destroy specific tumors. For metastatic urothelial bladder cancer, these therapies may be used to eliminate tumors, reduce symptoms caused by specific tumors, or to help a person live longer. For any treatment, it is important to know the goal and why that treatment is recommended.

Remember, treatment for metastatic urothelial bladder cancer is different for everyone. While it helps to understand the different treatment options available, your best source of information about your diagnosis and treatment will be your healthcare team.