Starting Immunotherapy: What to Expect

If you’ve had chemotherapy for metastatic bladder cancer, your doctor might try giving you immunotherapy after that first treatment is over. It’s another option for people who still have the disease even after chemo.

Certain immunotherapy drugs can be given to people with advanced bladder cancer who cannot tolerate chemotherapy.

The FDA has approved several immunotherapy drugs to treat this disease:

Once you and your doctor decide to start one of these treatments, it helps to know a bit about what you can expect while you’re getting it.  

How Do You Get Immunotherapy?

Your doctor will order some lab tests before and during your treatment to see how your body responds to the drug.

You take the medicine through a tube (an IV) that goes in one of your veins. You’ll have to go to a treatment center every 2 – 3 weeks. The first dose takes an hour, and any doses after that may take 30 minutes. Your doctor will decide how many rounds of treatment you need.

A doctor or nurse will look after you when you’re getting the IV to make sure you don’t have any bad reactions or side effects. If you do, your doctor might slow down the infusion, or delay or stop the treatment.

Speak up if you feel any of these while you’re getting treatment:

  • Flushing (turning red and feeling hot)
  • Chills
  • Shaky
  • Dizzy
  • Faint
  • Short of breath or trouble breathing
  • Itching
  • Rash
  • Pain in your back or neck
  • Puffy or swollen in your face

Side Effects

Even when you’re not at the treatment center getting the IV, these drugs can affect how you feel. Side effects can include:

  • Feeling tired
  • Not feeling hungry
  • Feeling sick to your stomach
  • Urinary tract infection (UTI or a bladder infection)
  • Constipation
  • Diarrhea
  • Rashes and itchy skin
  • Muscle pain or weakness
  • Joint aches

These problems might seem minor, but you should still bring them up with your doctor. He can prescribe medicines or let you know other things that can help you feel better while you’re getting treatment.


The drugs can have serious side effects. They can push your immune system to attack healthy parts of your body. Call your doctor if you get:

  • Coughs, trouble breathing, or chest pain
  • Yellow skin or eyes
  • Dark or brownish pee
  • Severe vomiting
  • Pain or cramping in your belly
  • Bloody or black poop
  • Problems seeing
  • Weakness in your limbs
  • Confusion
  • Rash

Some immunotherapy drugs can also affect your ability to have children. Talk to your doctor before you start treatment to figure out the options you have if you want to have a baby in the future.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on March 03, 2019



American Cancer Society: “Immunotherapy for Bladder Cancer.”

American Society of Clinical Oncology: “Bladder Cancer: Treatment Options.”

National Cancer Institute: “Immunotherapy,” “FDA Approves New Immunotherapy Drug for Bladder Cancer.”

National Institutes of Health, US National Library of Medicine: “Atezolizumab Injection.”

University of Pennsylvania OncoLink: “Atezolizumab (Tecentriq).”

FDA: “FDA Approves New, Targeted Treatment for Bladder Cancer,” “Nivolumab for Treatment of Urothelial Carcinoma.”

Cancer Research UK: “Nivolumab (Opdivo).”

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