When Your Immunotherapy Stops Working

One of the newer treatments for advanced metastatic bladder cancer is immunotherapy, which prompts your body’s immune system to fight the cancer.

This type of medicine is promising, but it doesn’t work for everyone who takes it. If you’ve tried it and it didn’t stop your cancer, you still have a few options.  What kind of treatment you get next depends on what others you’ve tried and what stage your cancer is in.

Chemotherapy

This treatment uses powerful drugs to kill cancer. Even if you’ve already tried some drugs before or along with your immunotherapy, your doctor may try other ones or different combinations of medicines to fight your cancer. Chemo drugs for the most common form of bladder cancer include:

  • Cisplatin
  • Docetaxel or paclitaxel
  • Gemcitabine

You’ll get chemotherapy in cycles with a few weeks in between to give your body time to recover.

Surgery

If you still have all or part of your bladder, your doctor might recommend an operation called a radical cystectomy. Your doctor will take out all of your bladder and the lymph nodes nearby. He might also remove some of your reproductive organs. For men, that could be the prostate gland and seminal vesicles. For women, it might be the ovaries, fallopian tubes, uterus, cervix, and a small part of the vagina.

After a radical cystectomy you’ll have another surgery called a urinary diversion to create a way for your body to store and let out pee.  Your doctor might use part of your small intestine or colon to direct the pee out of your body into a small pouch you would wear. Your doctor might be able to make a storage pouch for inside your body. Then you would only need to empty the pouch with a thin tube called a catheter. Another option is to connect the pouch to your urethra, the tube in your body through which pee comes out.

Clinical Trials

Scientists are always studying possible new treatments for bladder cancer. You might be able to join a research study called a clinical trial. Some clinical trials look at new ways of using treatments that are already available, like different combinations of drugs or new ways of doing radiation therapy. Others  involve treatments that are completely new. The goal of these studies is to see if treatments are safe and how well they work.

Continued

If you think you might want to join a clinical trial, your doctor will help you make the decision. She will talk about:

  • How the new treatment is different from the usual treatments you could get
  • What the risks are
  • Any tests you’ll need
  • How often you’ll get treatment

You’ll be able to leave the clinical trial whenever you want, for whatever reason you might have.

Palliative Care

Palliative care, sometimes called “supportive care,” aims to make you more comfortable during your treatment. It focuses on:

  • Helping to control cancer symptoms
  • Managing the side effects of treatment
  • Helping you have a better day-to-day life
  • Supporting you and your family

If your doctor suggests palliative care, it doesn’t mean she’s given up on treating you. You can get this care at any time during your cancer treatment. It might include:

  • Medication
  • Changes in what you eat
  • Ways of teaching you how to relax
WebMD Medical Reference Reviewed by Minesh Khatri, MD on February 10, 2019

Sources

SOURCES:

Sumanta Pal, MD, associate professor of medical oncology and experimental therapeutics, City of Hope, Los Angeles.

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

Radiological Society of North America and American College of Radiology (radiologyinfo.org): “External Beam Therapy,” “Brachytherapy.”

American Cancer Society: “Bladder Cancer Surgery.”

National Comprehensive Cancer Network: “NCCN Clinical Practice Guidelines in Oncology: Bladder Cancer.”

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