Most bladder cancer is urothelial carcinoma, which affects urothelial cells as opposed to other types of cells in the urinary system (kidney, bladder, urinary tract). Chemotherapy that contains platinum is the most effective against this type of cancer.
Chemotherapy combinations like MVAC (which uses the drugs methotrexate, vinblastine, Adriamycin [doxorubicin], and cisplatin) or gemcitabine and cisplatin are prescribed most often. These treatments have side effects that must be considered carefully if you cannot recover from your illness and the goal to optimize your quality of life. Limited ability to perform daily activities (low performance status), other illnesses, or decreased kidney function could make you ineligible for these chemotherapies.
If you have reduced kidney function and cannot take the drug cisplatin, combinations like gemcitabine and carboplatin or M-CAVI (which uses the drugs methotrexate, carboplatin, and vinblastine) are slightly less effective options for treating bladder cancer.
Should your disease recur or progress while taking these therapies, treatment can be changed to another type of chemotherapy. The drug vinflunine can be used if you have already taken cisplatin or carboplatin chemotherapy for bladder cancer. Additional surgery to remove a metastatic or recurrent tumour mass is used only to relieve pain or obstruction and will not cure the disease.
Some types of chemotherapy are quite intensive and can have a lot of side effects. If you are not fit or if you feel unwell from the cancer, these side effects can be quite severe. Older patients in particular may benefit from less intensive types of chemotherapy.
Depending on how well previous chemotherapy worked for you, your doctor will decide what type of chemotherapy you are likely to benefit from.
Treatment of bone metastases
When bladder cancer has spread to the bone, skeletal complications can occur, such as weakening of the bones. This causes pain and can have a detrimental effect on your quality of life. Your doctor may suggest drug treatment to help strengthen your bones and control the pain.