Treatment for muscle invasive bladder cancer
Immunotherapy works by helping the find and attack cancer cells. Targeted cancer drugs work by targeting certain features of cancer cells that help them to survive and grow.
Some drugs work in more than one way. So they can target cancer cells directly as well as helping the immune system attack the cancer.
The type of immunotherapy or targeted cancer drug you have depends on:
the type of bladder cancer you have
if you can have surgery
if the cancer has spread
other treatment you may have already had
if the cancer has certain proteins or gene changes
your general health and fitness
If you can have surgery for muscle invasive bladder cancer, you might have immunotherapy:
with chemotherapy before surgery - this is called neo adjuvant treatment
after surgery - this is called adjuvant treatment
Having treatment before and after surgery helps to reduce the risk of the cancer coming back.
Doctors also give immunotherapy for bladder cancer that has:
grown into nearby tissues or and can't be removed with surgery (unresectable locally advanced bladder cancer)
spread to other parts of the body (metastatic bladder cancer)
You might have a targeted cancer drug if your cancer can’t be removed with surgery. Or you have metastatic bladder cancer.
Not all targeted and immunotherapy drugs are suitable for everyone. Some of these treatments are only available if the cancer cells have certain proteins or gene changes. Testing your cancer cells can help your doctor find out which treatment may be helpful for you.
To do this, your doctor needs a sample of the cancer. They might be able to test a sample from a biopsy or operation you have already had. In some cases, you might need to have a second biopsy.
For bladder cancer, testing may include:
PD-L1
FGFR gene changes
Some bladder cancers have increased levels of a protein called PD-L1 on their surface. Cancer cells can use this protein to hide from the immune system and avoid being attacked.
Some immunotherapy drugs can block this process, helping the immune system find and attack the cancer cells.
If cancer cells have increased levels of PD-L1 you might have immunotherapy drugs such as nivolumab and atezolizumab.
Fibroblast growth factor receptors (FGFR) are a family of proteins on the surface of cells that help control cell growth.
Some bladder cancers have changes to the FGFR gene. These changes can cause cancer cells to grow in an uncontrolled way.
Targeted cancer drugs called FGFR inhibitors block this activity and helps slow down or stop cancer growth.
An example of an FGFR inhibitor is erdafitinib.
There are a number of immunotherapy drugs that doctors might use to treat muscle invasive bladder cancer.
There are two targeted cancer drugs for muscle invasive bladder cancer:
Read more about targeted cancer drugs and immunotherapy
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.
Most of the cancer drugs mentioned on this page are available on the NHS throughout the UK. But currently, pembrolizumab on its own for advanced bladder cancer is only approved in Scotland. There are other immunotherapy drugs available for advanced bladder cancer on the NHS across the UK.
Read about access to treatment
You can have cancer drugs for bladder cancer as:
tablets that you swallow
an injection under the skin (subcutaneous injection)
liquids that go directly into your bloodstream as a drip (intravenous infusion)
You take erdafitinib as a tablet.
You should take the right dose, not more or less.
Talk to your healthcare team before you stop taking a cancer drug, or if you miss a dose.
You might have nivolumab, pembrolizumab and atezolizumab as an injection under the skin. You may sometimes have pembrolizumab into your bloodstream (intravenously).
You usually have these cancer drug injections into your thigh over a few minutes. You might have stinging or a dull ache for a short time after this type of injection. The skin in the area may go red and itchy for a while.
You have enfortumab vedotin and some immunotherapy drugs through a thin short tube that goes into a vein in your arm. This tube is called a cannula.
Or you might have these drugs through a long line, such as:
a central line
PICC line
portacath (also called a port)
These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment. This means your doctor or nurse won't have to put in a cannula every time you have treatment.
Read more about how you have cancer drugs
The side effects of immunotherapy and targeted cancer drugs are different depending on the drug you’re having. Not everyone gets all side effects.
The side effects that you might have also depend on:
whether you have it alone or with other cancer drugs
the amount of drug you have (the dose)
your general health
A side effect may get better or worse during your course of treatment. Or more side effects may develop as the treatment goes on. For more information about the side effects of your treatment, go to the individual drug pages.
Researchers are looking at different types of treatment for bladder cancer. These include many different types of immunotherapy and targeted cancer drugs.
They are looking at these drugs on their own or combined with other treatments.
Last reviewed: 09 Oct 2026
Next review due: 09 May 2027
Your treatment options depend on the stage, type and grade of your bladder cancer. Treatments include BCG or chemotherapy into the bladder, surgery, radiotherapy, and chemotherapy into your bloodstream.
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 and people who can help you to cope.
Researchers are looking into better ways to diagnose and treat bladder cancer. Talk to your cancer specialist if you are interested in taking part in a clinical trial.
Bladder cancer starts in the inner lining of the bladder. The bladder stores urine and is in the lower part of your tummy (abdomen).
