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Medicine treatment for bladder cancer

For bladder cancer that has spread beyond the bladder, drug treatments can help control the cancer, relieve symptoms, and improve quality of life. Your doctor will discuss which option is best for you, based on your overall health, kidney function, and previous treatments.

First-line treatment options

Treatment often includes newer drug combinations or traditional chemotherapy:

  • Targeted therapy + immunotherapy: A combination of enfortumab vedotin (EV), a targeted therapy, and pembrolizumab, an immunotherapy drug, may be offered. EV delivers medicine directly to cancer cells, while pembrolizumab helps your immune system fight the cancer. This approach can help slow cancer growth and improve symptoms.
  • Chemotherapy: Traditional chemotherapy drugs, such as cisplatin or gemcitabine, may be used alone or with immunotherapy. These drugs work by killing cancer cells throughout the body.
  • Immunotherapy alone: If chemotherapy isn’t suitable, immunotherapy drugs like pembrolizumab or atezolizumab may be used, depending on tests and your overall health.

This chapter contains general information about drug treatments for bladder cancer. It is not a substitute for professional medical advice or treatment. Always consult your doctor or healthcare provider for guidance on your individual medical situation.

Last updated: November 2025

Reviewed by: 

  • Mr. Alex Filicevas (Patient Office EPAG)
  • Dr. Laura Mertens (EAU Working Group on Muscle-Invasive and Metastatic Bladder Cancer)