Intravesical Therapy

December 5, 2024

What is intravesical therapy?

Intravesical therapy is a treatment that puts medicine directly into the bladder. This way, the medicine goes straight to the cancer cells without affecting the rest of the body. It is  helpful for treating tumors that are hard to remove, like CIS, or high-risk non-muscle invasive bladder cancer (NMIBC), which is more likely to return after surgery. The treatment is given through a small tube called a catheter, and patients hold the medicine in their bladder for a certain time before it is drained out.

Intravesical Therapy for NMIBC (non-muscle invasive bladder cancer) includes:

BCG (Bacille Calmette-Guerin) Immunotherapy

BCG is a type of immunotherapy that uses weakened bacteria to activate the immune system against bladder cancer cells. It’s administered directly into the bladder for patients with high-grade, non-invasive bladder cancers, like CIS or T1 tumors that have not spread into the muscle. BCG is usually given in an initial six-week cycle, and doctors may recommend additional maintenance doses to help reduce the risk of cancer coming back. BCG has been effective for many patients, though it can cause side effects like bladder irritation, fever, or mild bleeding.

Adstiladrin (Nadofaragene Firadenovec-vncg)

Adstiladrin is a gene therapy approved for patients with carcinoma in situ (CIS) who did not respond to BCG. Delivered directly into the bladder, Adstiladrin introduces a gene called interferon alpha-2b, which activates immune cells to target and kill cancer cells. This local approach minimizes side effects outside of the bladder, although some patients may experience bladder irritation. For some, Adstiladrin can be effective in reducing or eliminating cancer that remains after BCG treatment

Anktiva (Nogapendekin Alfa Inbakicept-pmln)

Anktiva is an immunotherapy that enhances the immune response against bladder cancer by activating a protein called interleukin-15. It’s approved for patients with CIS who didn’t respond to BCG and is used together with BCG to boost its effectiveness. Delivered through a catheter into the bladder, Anktiva can help reduce cancer in some patients, though results vary. Side effects are usually limited to the bladder, including irritation.

BCG, Adstiladrin, and Anktiva all work to stimulate the immune system to fight cancer cells in the bladder. This is different from other immunotherapies like checkpoint inhibitors, which block pathways cancer cells use to hide from the immune system. Each therapy has its own side effects and benefits, so it is important to talk with your doctor about which might work best for your type of cancer and treatment plan.

Other Intravesical Therapies

Chemotherapy (chemo) drugs can be put right into the bladder through a catheter. These drugs kill actively growing cancer cells. Intravesical chemotherapy is most often used when intravesical immunotherapy with BCG doesn’t work. Giving chemo right into the bladder instead of injecting it into the bloodstream means these medicines that can kill cancer, usually do not reach and effect other parts of the body. This helps people avoid many of the side common effects that a person who receives systemic chemotherapy might experience.

Intravesical chemotherapy is a treatment for bladder cancer that also puts special medicine directly into the bladder using a thin tube called a catheter. This type of chemotherapy is usually used when another treatment called BCG does not work. By delivering the medicine straight to the bladder, it targets the cancer cells without affecting other parts of the body. This helps to reduce many of the side effects that people might have if they received chemotherapy through their bloodstream.

Gemcitabine

Gemcitabine is a medicine that can help stop bladder tumors from coming back after surgery (TURBT). It is usually well tolerated, meaning most people don’t have serious side effects. Some people may have minor problems, like needing to urinate more often. When taken with another medicine known as oral alkalization (a method to help balance acidity), it causes very few side effects like nausea, vomiting, hair loss, or low blood counts.

Mitomycin C

Mitomycin C is another medicine used after TURBT that can help reduce the chance of bladder tumors returning by up to 50%. One good thing about Mitomycin C is that it does not easily enter the bloodstream, which makes it less risky than chemotherapy given through an IV. Some side effects can include pain when urinating or irritation of the bladder lining, which can feel like a urinary tract infection. These side effects are temporary and will go away once the treatment stops.

Gemcitabine with Docetaxel

Gemcitabine with Docetaxel treatment combines gemcitabine with another medicine called docetaxel, and both are given directly into the bladder in a series of visits to the doctor’s office after TURBT. The side effects are similar to those of gemcitabine alone, and during the visit, one drug is given, drained out of the bladder, and then the second drug is administered.

Vicinium

Vicinium is a treatment for patients whose cancer has returned after BCG therapy. It targets a specific part of the cancer cells in the bladder. About half of the patients may have side effects, but most of these are not serious. Vicinium requires a more frequent treatment schedule, starting with two times a week for six weeks, then weekly for six weeks, and then every other week for two years. It is important to note that Vicinium is not yet approved by the U.S. Food and Drug Administration.

Valrubicin

Valrubicin may also be given to some patients, especially if their carcinoma in situ (CIS) bladder cancer has not responded to BCG treatment and they cannot have surgery right away to remove the bladder.

Questions for Your Doctor

Discuss with your doctor which intravesical therapy might suit your situation, how long treatment might last, and what side effects to monitor.