Patients with recurrent bladder cancer have cancer that has returned following initial treatment with surgery, radiation, chemotherapy or immunotherapy.
A variety of factors ultimately influence a patient’s decision to receive treatment of cancer. The purpose of receiving cancer treatment may be to improve symptoms through local control of the cancer, increase a patient’s chance of cure, or prolong a patient’s survival. The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment.
Because the majority of patients with recurrent bladder cancer have disease that has already spread and cannot be removed with surgery, systemic treatment that can kill cancer cells throughout the body are necessary. Standard treatment consists of chemotherapy, immunotherapy with precision cancer medicines, and occasionally surgery and radiation. Participation in a clinical trial should be considered and may offer access to better treatments and advance the existing knowledge about treatment of bladder cancer.
The following is a general overview of the treatment of recurrent bladder cancer. Circumstances unique to your situation and prognostic factors of your cancer may ultimately influence how these general treatment principles are applied to your situation. The information on this Web site is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician.
Recurrent Superficial Bladder Cancer
Patients with a diagnosis of superficial bladder cancer have frequent recurrences of cancer throughout their lives. Most of the time, these recurrences are non-invasive and not life threatening. Treatment of recurrent superficial bladder cancer essentially uses the same treatment approaches as were initially offered. Go to Stage I to learn about treatment options. In some instances, partial or total bladder resection may be utilized to control recurrent superficial bladder cancers. To learn more, go to Surgery for Bladder Cancer.
Treatment of Patients with Superficial Bladder Cancer That Progress to Stage II-IV Bladder Cancer
Approximately 20-40% of all patients with superficial bladder cancer will ultimately progress to more advanced stages or muscle invasive bladder cancer. When this occurs, patients are treated based on new staging of the current more invasive bladder cancer. For treatment of patients with superficial bladder cancer who have progressed, select one of the following:
Patients who experience a recurrence after initial treatment for stage II-IV bladder cancer may be treated with cystectomy (if not performed previously), chemotherapy, radiation therapy, or enrollment in a clinical trial.
Strategies to Improve Treatment
Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the effectiveness of new treatment strategies. The development of more effective cancer treatment for bladder cancer requires that new and innovative therapies be evaluated in patients. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of bladder cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits with their physician.
New Chemotherapy Regimens: Development of new multi-drug chemotherapy treatment regimens that incorporate new or additional anti-cancer therapies for use as treatment is an active area of clinical research carried out in phase II clinical trials.
Precision Cancer Medicines: The purpose of precision cancer medicine is not to categorize or classify cancers solely by site of origin, but to define the genomic alterations in the cancers DNA that are driving that specific cancer. Precision cancer medicine utilizes molecular diagnostic testing, including DNA sequencing, to identify cancer-driving abnormalities in a cancer’s genome. Once a genetic abnormality is identified, a specific targeted therapy can be designed to attack a specific mutation or other cancer-related change in the DNA programming of the cancer cells.
Precision cancer medicine uses targeted drugs and immunotherapies engineered to directly attack the cancer cells with specific abnormalities, leaving normal cells largely unharmed. Precision medicines are being developed for the treatment of bladder cancer and patients should ask their doctor about undergoing genomic testing to determine whether treatment with a precision cancer medicine is an option. Individuals should consider participating in clinical trials evaluating precision medicines alone or in combination with other systemic cancer treatments such as chemotherapy.
Immunotherapy: The goal of immunotherapy is to help the immune system recognize and eliminate cancer cells by either activating the immune system directly, or by inhibiting mechanisms of suppression of the cancer.
The immune system is an elaborate network of cells and organs that protect the body from infection. The immune system is also part of the body’s innate disease-fighting capability to treat cancer. With cancer, part of the problem is an ineffective immune system. The immune system recognizes cancer cells as foreign and up to a point can get rid of them or keep them in check. Cancer cells are very good at finding ways to hide from, suppress, or wear out the immune system and avoid immune destruction. The immune system may not attack cancer cells because it fails to recognize them as foreign and harmful.
General types of immunotherapy include interferon, interleukin, and colony stimulating factors (cytokines), which generally activate the immune system to attack the cancer. These general immunotherapies however are not specific and their activation of the immune system can cause severe side effects by attacking normal cells along with cancer cells. Immunotherapy treatment of cancer has progressed considerably over the past 30 years and has evolved from a general to more precisely targeted immunotherapy treatment. Examples of precision immunotherapy include checkpoint inhibitors, CAR T cells, and vaccines.
In an attempt to improve the chance of cure, immunotherapies are being tested alone or in combination with chemotherapy in clinical trials.
Phase I Clinical Trials: New chemotherapy or immunotherapy drugs continue to be developed and evaluated in patients with recurrent cancers in phase I clinical trials. The purpose of phase I trials is to evaluate new anti-cancer medications in order to determine the safety and tolerability of a drug and the best way of administering the drug to patients.
Hussain MHA, MacVicar GR, Petrylak DP et al. Trastuzumab, paclitaxel, carboplatin, and gemcitabine in advanced human epidermal growth factor receptor-2/neu-positive urothelial carcinoma: results of a multicenter phase II National Cancer Institute Trial. Journal of Clinical Oncology. 2007;25:2218-2224.