Chemotherapy for Bladder Cancer

 

Chemotherapy drugs are used to kill cancer cells. Chemotherapy can be used to eliminate tumors and help with symptoms.

Chemotherapy is called adjuvant treatment (additional) when it is given after surgery to prevent the cancer from coming back. Even if the surgery removes the original (primary) tumor, a small number of cancer cells might have escaped to other parts of the body. The chemotherapy is used to get rid of these cells.

Chemotherapy is neoadjuvant when it is given before surgery to help shrink the tumor.

Chemotherapy for bladder cancer is usually given in one of two ways:

Intravesical (local) chemotherapy - A urinary catheter (thin, flexible tube) is used to deliver the anticancer drugs directly into the bladder. These drugs can reach cancer cells near the bladder lining. Because the drugs do not usually spread throughout the body, this limits the unwanted side effects that can occur with systemic chemotherapy.

Intravesical chemotherapy is used only for noninvasive (stage 0) or minimally invasive (stage I) bladder cancers because it does not reach cancer cells in the kidneys, ureters, and urethra; cancer cells that may have invaded deeply into the bladder wall; or cancer cells that have spread to other organs.

The drugs used most often for intravesical chemotherapy for bladder cancer are:

  • Adriamycin® (doxorubicin) - Doxorubicin hydrochloride belongs to the group of chemotherapy drugs known as anthracycline antibiotics. Doxorubicin stops the growth of cancer cells, causing them to die. This drug is given by a shot in a vein over about 15 minutes. The dose and how often you get the medicine depend on your size, your blood counts, how well your liver works, and the type of cancer you have.
  • Mutamycin® (mitomycin) - Mitomycin belongs to a group of chemotherapy drugs known as antibiotics but it acts like an alkylating agent. It blocks the cell from making DNA, which results in cell death. Mitomycin is given by an injection in a vein over 20 minutes every 6 to 8 weeks. The dose and how often you get the medicine depend on your weight, your blood counts, how well your kidneys work, and the type of cancer you have.
  • Thioplex® (thiotepa) - Thiotepa belongs to the group of chemotherapy drugs known as alkylating agents. It stops the growth of cancer cells, causing them to die. Thiotepa is given by an injection in a vein or muscle or under the skin. It can also be given directly into the bladder. The dose depends on your weight and the type of cancer.

Systemic (whole-body) chemotherapy - Anticancer drugs are injected into a vein. These medicines travel through the bloodstream to all parts of the body. Unlike intravesical chemotherapy, systemic chemotherapy can attack cancer cells that have already spread beyond the bladder to lymph nodes (small, bean-shaped collections of immune system cells that help fight infections) and other organs. These drugs kill cancer cells but can also damage some normal cells. This damage to normal cells can cause side effects.

The drugs used most often for systemic chemotherapy for bladder cancer are:

  • Adriamycin® (doxorubicin) - Doxorubicin hydrochloride belongs to the group of chemotherapy drugs known as anthracycline antibiotics. It stops the growth of cancer cells, causing them to die. This drug is given by a shot in a vein over about 15 minutes. The dose and how often you get the medicine depend on your size, your blood counts, how well your liver works, and the type of cancer you have.
  • Cytoxan® or Neosar® (cyclophosphamide) - Cyclophosphamide belongs to a group of chemotherapy drugs known as alkylating agents. It stops the growth of cancer cells, causing them to die. This drug can be given by mouth as a pill or liquid, or by a shot into a vein. The dose depends upon your size and your type of cancer.
  • Gemzar® (gemcitabine) - Gemcitabine belongs to a group of chemotherapy drugs known as antimetabolites. It prevents cells from making DNA and RNA, which stops the growth of cancer cells and causes the cells to die. Gemcitabine is given by an injection in a vein over 30 minutes. It is usually given once a week for 3 weeks, followed by a week off. The dose depends on your size, your blood counts, and type of cancer you have.
  • Platinol® (cisplatin) - Cisplatin is a platinum compound chemotherapy drug that acts like an alkylating agent. It stops the growth of cancer cells, causing them to die. Cisplatin is given by an injection into the vein over at least 1 hour. Your dose depends upon the type of cancer you have, your size, and how well your kidneys work.
  • Rheumatrex® or Trexall™ (methotrexate) - Methotrexate belongs to a group of chemotherapy drugs known as antimetabolites. It prevents cells from making DNA and RNA, which stops the growth of cancer cells. Methotrexate is given as a pill by mouth, an injection in a vein for up to 20 minutes, or an injection into a muscle. The dose depends on your size, the type of cancer you have, and how well your kidneys work.
  • Taxol® or Onxol® (paclitaxel) - Paclitaxel belongs to the group of chemotherapy drugs known as taxanes. It is also called a mitotic inhibitor because it affects the cell during mitosis (cell division). It stops cell division, resulting in cell death. Paclitaxel is given by an injection in a vein, usually over a 3-hour period, every 3 weeks. Sometimes, smaller doses are given once a week over shorter periods. The dose depends on your weight, how well your liver works, the side effects you experience, and how often the medicine is given.
  • Velban® (vinblastine) - Vinblastine belongs to the group of chemotherapy drugs known as plant (vinca) alkaloids. It stops cell division, resulting in cell death. Vinblastine is given by an injection in a vein over 5 to 10 minutes. The dose and how often you get the medicine depends on your weight, your blood counts, how well your liver works, and the type of cancer you have.

Combinations of chemotherapy drugs are often more effective than individual drugs in treating bladder cancer. The combinations used most often for bladder cancer are:

  • M-VAC (methotrexate, vinblastine, doxorubicin, and cisplatin)
  • MCV (methotrexate, cisplatin, and vinblastine)
  • GemCIS (gemcitabine and cisplatin)

This content has been reviewed and approved by Myo Thant, MD.

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