Chemotherapy for metastatic bladder cancer

Chemotherapy is a common treatment for metastatic bladder cancer. Chemotherapy uses anti cancer drugs to destroy cancer. The drugs circulate throughout the body in the bloodstream.

Metastatic bladder cancer means the cancer has spread to another part of your body. It is also called advanced cancer. Chemotherapy for metastatic bladder cancer can often shrink the cancer or keep it under control for some time.

There are different types of chemotherapy drugs. You usually have a combination of drugs together. 

When do you have it?

Some chemotherapy treatments for advanced bladder cancer can be quite intensive and have a lot of side effects. So when they make treatment decisions, your doctor will think about:

  • how unwell you are because of your cancer
  • what other medical problems you have (such heart, lung or liver problems)
  • what cancer treatment you have had before
  • how well your kidneys are working
  • the side effects of the chemotherapy
  • what other treatment options there are

You can have less intensive types of chemotherapy if the doctor doesn’t think you are well enough to manage the side effects of the more intensive treatments. They can still work very well at shrinking the cancer and slowing its growth. 

What chemotherapy will I have?

Some of the common chemotherapy combinations for metastatic bladder cancer include:

  • accelerated MVAC (methotrexate, vinblastine, doxorubicin and cisplatin)
  • MVAC
  • Gemcitabine and Cisplatin
  • Gemcitabine and Carboplatin

It’s best to talk to your doctor about what type of chemotherapy treatment they think is most suitable for you and why. 

If you had chemotherapy when you were first treated, your doctor will assess how well the chemotherapy worked for you then. Then they can decide whether it is likely to work well now, or whether other chemotherapy drugs might work better for you.

How you have chemotherapy

Before you start

You need to have blood tests to make sure it’s safe to start treatment. You usually have these a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Having chemotherapy

You have chemotherapy into a vein (intravenously). This means you have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

You usually have chemotherapy as cycles of treatment. Each cycle is either a 2, 3 or 4 week period. The cycle length varies in time depending on the chemotherapy you are having. 

You usually have 3 cycles of chemotherapy before surgery or radiotherapy. After surgery or radiotherapy, you might have 6 or more cycles.

Your specialist will explain how you have treatment, and how long they expect your treatment course to be.

Where do you have it?

You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.

You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.

For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.

Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.

Side effects

Common chemotherapy side effects include:

  • feeling sick
  • loss of appetite
  • losing weight
  • feeling very tired
  • increased risk of getting an infection
  • bleeding and bruising easily
  • diarrhoea or constipation
  • hair loss
Contact your doctor or nurse immediately if you have signs of infection. These include a temperature above 37.5C or below 36C, or generally feeling unwell. Infections can make you very unwell very quickly.

Side effects depend on:

  • which drugs you have
  • how much of each drug you have
  • how you react

Tell your treatment team about any side effects that you have.

Dietary or herbal supplements and chemotherapy

Let your doctors know if you:

  • take any supplements
  • have been prescribed anything by alternative or complementary therapy practitioners

It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.

Cancer Research UK nurses

For support and information, you can call the Cancer Research UK information nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday.
  • Bladder cancer: diagnosis and management
    National Institute for Health and Care Excellence (NICE), February 2015

  • BMJ Best Practice. Bladder Cancer
    D Lamm and others
    BMJ Publishing Group Ltd, 2018

  • Bladder cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up.
    T Powles and others
    Annals of oncology, 2022 Volume 33, Issue 3, Page 244 - 258

  • EAU Guideline on Muscle-invasive and Metastatic Bladder Cancer
    J A Witjes and others
    European Association of Urology, 2022

  • Bladder Cancer
    J H Ku and others
    Eldevier Inc, 2018

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact with details of the particular issue you are interested in if you need additional references for this information.

Last reviewed: 
09 Dec 2022
Next review due: 
09 Dec 2025

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