Muscle invasive bladder cancer treatment
Immunotherapy uses our immune system to fight cancer. It works by helping the immune system recognise and attack cancer cells.
You might have immunotherapy after your surgery. This is to lower the risk of your cancer coming back. This is called adjuvant treatment. You can have immunotherapy if:
you have a high risk of your cancer coming back, but chemotherapy isn't suitable
your cancer makes high levels of a protein called PD-L1.
You might also have immunotherapy if your bladder cancer has spread to other parts of your body (metastatic cancer). Or if your cancer has spread to nearby tissues or lymph nodes and your surgeon can’t remove it. Doctors call this inoperable locally advanced bladder cancer.
You can have it:
straight after chemotherapy – this is sometimes called maintenance treatment
as your first treatment if you can’t have chemotherapy and your cancer has high levels of PD-L1
as your second treatment, if you’ve had chemotherapy in the past (even if you don't have high levels of PD-L1)
You might have one of the following drugs for muscle invasive bladder cancer:
nivolumab (Opdivo)
avelumab (Bavencio)
atezolizumab (Tecentriq)
pembrolizumab (Keytruda)
These immunotherapy drugs work by blocking proteins called PD1 and PD-L1. This protein stops the immune system from working properly and attacking cancer cells. It helps to make your immune system find and kill cancer cells.
Read more about immunotherapy and how it works
Your doctor might test your cancer cells for particular proteins such as PD-L1. This can help to show whether certain drug treatments might work for your cancer.
To test your cancer cells, your specialist needs a sample (biopsy) of your cancer. They might have tested your cancer cells when you were first diagnosed. Or they might be able to test some tissue from a biopsy or operation you have already had.
In some cases, you might need to have a second biopsy.
Some bladder cancers make high levels of a protein called PD-L1. PD-L1 can switch off immune cells called T cells. So the T cells can no longer recognise and kill cancer cells.
You might have nivolumab or atezolizumab if your cancer has high levels of PD-L1. These drugs are both immunotherapy checkpoint inhibitors. They stop the proteins on the cancer cells from switching off the T cells. This means the T cells can find and attack the cancer cells.
New cancer drugs are licensed for use in a particular way. For example, a drug might have a license to treat a particular stage or type of bladder cancer.
Once a drug gets a license, several independent organisations approve the new cancer drug. This happens before doctors can prescribe it on the NHS.
In England the National Institute for Health and Care Excellence (NICE) does this. NICE decides which drugs and treatments are available on the NHS.
In Wales, the All Wales Medicines Strategy Group (AWMSG) advises NHS Wales. They generally follow NICE decisions but can also issue their own guidance,
The Scottish Medicines Consortium (SMC) advises NHS Scotland. Its decisions are separate from decisions made by NICE.
The Department of Health advises about health and social care in Northern Ireland. They usually follow NICE decisions.
You have your treatment through a tube into your bloodstream.
You have the treatment through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.
You may need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.
Find out about having a central line
Immunotherapy drugs can cause different side effects. Some of these can be serious. Your doctor or nurse will talk to you about this. Always tell them about any side effects you have and follow the advice they give you.
Choose a drug on our A to Z list to read about side effects and find out more about the drug.
Researchers are looking at different types of treatment for bladder cancer. These include many different types of immunotherapy drugs.
They are looking at these drugs on their own or combined with other treatments.
Last reviewed: 09 May 2024
Next review due: 09 May 2027
Muscle invasive bladder cancer has spread into or through the muscle layer of the bladder. The main treatments include surgery, radiotherapy and chemotherapy.
Metastatic bladder cancer means that a cancer that began in the bladder has spread to another part of the body.
Coping with bladder cancer can be difficult. There are things you can do to help, and people who can support you practically and emotionally.
Bladder cancer is cancer that starts in the lining of the bladder. The bladder is part of the urinary system, which filters waste products out of your blood and makes urine. Find out about the symptoms, how you are diagnosed, treatment, living with bladder cancer and follow up.
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