Bladder Cancer: Immunotherapy
What is immunotherapy?
Immunotherapy is sometimes used to make the body's own immune system fight cancer. This type of treatment is sometimes called biological therapy. For this treatment, medicines are used to make the body’s own immune system attack and kill cancer cells. Its goal is to kill cancer cells without having to remove the bladder. It can also help keep cancer from coming back after treatment.
When might immunotherapy be used for bladder cancer?
Your healthcare provider may suggest this treatment if you have early-stage, superficial bladder cancer. This means the cancer is small and has not spread beyond the lining of your bladder.
How is immunotherapy given for bladder cancer?
The most common way to give this treatment for bladder cancer is intravesically. That means the medicines are placed directly into your bladder instead of injected into your blood or taken as pills. Early-stage bladder cancer can often be treated with the medicine bacillus calmette-guerin (BCG). BCG is put into your bladder through a catheter in your urethra. Your body’s immune system responds to BCG and is "turned on" to attack and kill the bladder cancer cells.
You go to your healthcare provider’s office or an outpatient clinic to have this done. For the 8 to 12 hours before treatment, you should drink only a small amount of water. In the last 4 hours before the treatment, you should not drink any liquids. Your bladder needs to be almost fully empty for BCG to work.
Your healthcare provider puts a catheter through your urethra into your bladder. This isn’t painful. But you’ll feel some discomfort when the catheter goes through the urethra. Any urine left in your bladder drains out through the catheter. Then your healthcare provider will put the medicine into the catheter.
Sometimes the catheter is left in place. Then the medicine is drained out through it when treatment is over. In some cases, the catheter is removed after the BCG has been put into the bladder. When the catheter is taken out after the medicine is put in, you should do your best not to urinate for at least 2 hours. This allows the medicine to stay in your bladder long enough to activate your immune system to kill cancer cells. You’ll lie flat while the medicine is in your bladder. You’ll be asked to change position from time to time to make sure the medicine reaches all parts of the bladder lining. After you urinate, the medicine will come out of the bladder in your urine.
Because BCG is made up of live bacteria, it’s important to follow instructions about handling your urine after treatment. Wash your hands after urinating. Your healthcare provider may tell you to add bleach to the toilet water for the first few hours after the treatment to kill the bacteria in the urine.
Your healthcare provider will ask you to drink a lot of water starting about 2 hours after the procedure. This will dilute the medicine that remains in your bladder. It will also reduce bladder irritation, fever, and other side effects.
Most people have 6 weekly treatments at first. Follow-up treatment is often scheduled over the next 12 to 24 months. Follow-up treatments may be given once a month or less often. For instance, you may receive them once every 3 months. These treatments are called maintenance BCG treatments. They help keep the cancer from coming back.
What are common side effects of immunotherapy?
Side effects can include the following:
Discomfort or burning in your bladder
Feeling the need to urinate often
Flu-like symptoms, such as chills, fatigue, or fever
Serious infection if BCG spreads through your body (this is rare)
These side effects often go away within a few days after the treatment.
Working with your healthcare provider
Talk with your healthcare providers about what signs to look for and when to call them. For example, it's normal to have a slight fever after immunotherapy. However, if you have a lingering fever of 101.5°F (38.6°C) or higher or other symptoms that last for more than 2 days, call your healthcare provider. It could be a sign of infection. Make sure you know what number to call with questions or problems. Is there a different number for evenings and weekends?
It may be helpful to keep a diary of your side effects. Write down physical, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.