Combination Therapy for Metastatic Bladder Cancer

If you have metastatic bladder cancer, your doctor is likely to give you a combination of treatments to fight the disease. Most people need more than one approach to get rid of all the cancer cells, especially because the disease has spread to different parts of the body.

Many people with bladder cancer need surgery. But in most cases of metastatic bladder cancer, surgery can’t remove all of the disease. So you’ll need other treatments along with, or instead of, an operation. These could include chemotherapy, radiation, and immunotherapy.


If your tumor is spreading rapidly, is in many places, or has moved into the wall of the bladder, your surgeon may remove the entire organ along with nearby lymph nodes. This procedure is called a radical cystectomy.

If your cancer has spread further, the surgeon can also remove nearby reproductive organs and structures. In women, this can mean the uterus, cervix, part of the vagina, the ovaries, and the fallopian tubes. In men, this usually means the prostate gland and can also include the seminal vesicles and vas deferens.

Chemotherapy Before Surgery

You will most likely get chemotherapy first, before your operation. It can help shrink tumors, which makes them easier to remove and makes surgery safer. This also makes it less likely that the cancer will come back.

Doctors often use the chemo drug cisplatin to treat the most common type of bladder cancer, called urothelial carcinoma. Cisplatin works by damaging the DNA of cancer cells so they can’t reproduce.

Cisplatin is often used along with other chemotherapy drugs. The most common combinations are:

If your kidneys don’t work well, you may get a different set of chemo drugs, such as carboplatin and either paclitaxel, gemcitabine, or docetaxel.

Also, if you have another, rarer form of bladder cancer, your chemo drugs may be different.

You get chemotherapy for metastatic bladder cancer either in pill form or through injections into your muscle or a vein.


Treatments After or Instead of Surgery

Chemo after surgery is designed to kill any cancer cells that remain in your body but were too small or scattered for your surgeon to remove them. It lowers the chance that your cancer will return.

You get chemotherapy in cycles, giving you time between treatments to recover. Each cycle usually lasts for a few weeks, and total treatment time may be several months.

Sometimes, doctors will use a mix of chemotherapy and radiation therapy to avoid doing surgery to remove the bladder. It can be a good option if you’re not healthy enough for surgery. In this case, you will likely take the chemo drug cisplatin by itself, cisplatin and fluorouracil, or mitomycin with fluorouracil.

You may also get chemotherapy and radiation together after surgery if your cancer has grown into the muscle layer of the bladder but hasn’t spread elsewhere.

With radiation therapy, you will get small doses of radiation delivered precisely to your tumor. Most people get it once a day, 5 days a week for several weeks.

If your cancer spreads after chemo, you can try other chemotherapy drugs or other types of medicine, like immunotherapy.


This treatment uses your immune system to attack the cancer. It helps your immune system recognize cancer cells as dangers and launch a stronger response against them. That can shrink tumors or stop them from growing.

The FDA has approved several immunotherapy drugs for people with metastatic bladder cancer whose disease got worse during chemo. These medications are: atezolizumab (Tecentriq), avelumab (Bavencio), durvalumab (Imfinzi), enfortumab vedotin-ejfv (Padcev), nivolumab (Opdivo), and pembrolizumab (Keytruda).

Scientists are testing other immunotherapy drugs in clinical trials to see how well they fight metastatic bladder cancer.

WebMD Medical Reference Reviewed by Nazia Q Bandukwala, DO on January 14, 2020



NYU Langone Medical Center: “Intravesical Treatment for Bladder Cancer,” “Radiation Therapy for Bladder Cancer,” “Surgery for Bladder Cancer,” “Chemotherapy and New Treatments for Bladder Cancer.”

American Cancer Society: “Chemotherapy for bladder cancer.”

Memorial Sloan Kettering Cancer Center: “Neoadjuvant Chemotherapy for Bladder Cancer,” “Bladder Cancer Clinical Trials and Research.”

FDA:  “FDA approves new, targeted treatment for bladder cancer,” “Nivolumab for Treatment of Urothelial Carcinoma.”

ISRN Urology: “Metastatic Bladder Cancer: A Review of Current Management.”

National Cancer Institute: "FDA Approves Immunotherapy Drugs for Patients with Bladder Cancer."

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