Immunotherapy for bladder cancer
Immunotherapy uses our immune system to fight cancer. It works by helping the immune system recognise and attack cancer cells.
The main immunotherapy drugs for muscle invasive bladder cancer are:
- nivolumab (Opdivo)
- avelumab (Bavencio)
- atezolizumab (Tecentriq)
Muscle invasive bladder cancer means that the cancer cells have spread into or through the muscle layer of the bladder wall.
When you might have immunotherapy drugs for bladder cancer
You might have immunotherapy after your surgery. This is to lower the risk of your cancer coming back. This is called adjuvant treatment. You can have immunotherapy if:
- you have a high risk of your cancer coming back, but chemotherapy isn't suitable
- your cancer makes high levels of a protein called PD-L1.
You might also have immunotherapy if your bladder cancer has spread to other parts of your body (metastatic cancer). Or if your cancer has spread to nearby tissues or lymph nodes and your surgeon can’t remove it. Doctors call this inoperable locally advanced bladder cancer.
You can have it:
- straight after chemotherapy – this is sometimes called maintenance treatment
- as your first treatment if you can’t have chemotherapy and your cancer has high levels of PD-L1
- as your second treatment, if you’ve had chemotherapy in the past (even if you don't have high levels of PD-L1)
Types of immunotherapy drugs for bladder cancer
You might have one of the following drugs for muscle invasive bladder cancer:
- nivolumab (Opdivo)
- avelumab (Bavencio)
- atezolizumab (Tecentriq)
- pembrolizumab (Keytruda)
These immunotherapy drugs work by blocking proteins called PD1 and PD-L1. This protein stops the immune system from working properly and attacking cancer cells. It helps to make your immune system find and kill cancer cells.
Tests on your cancer cells
Your doctor might test your cancer cells for particular proteins such as PD-L1. This can help to show whether certain drug treatments might work for your cancer.
To test your cancer cells, your specialist needs a sample (biopsy) of your cancer. They might have tested your cancer cells when you were first diagnosed. Or they might be able to test some tissue from a biopsy or operation you have already had.
In some cases, you might need to have a second biopsy.
PD-L1
Some bladder cancers make high levels of a protein called PD-L1. PD-L1 can switch off immune cells called T cells. So the T cells can no longer recognise and kill cancer cells.
You might have nivolumab or atezolizumab if your cancer has high levels of PD-L1. These drugs are both immunotherapy checkpoint inhibitors. They stop the proteins on the cancer cells from switching off the T cells. This means the T cells can find and attack the cancer cells.
Are these drugs available in the UK?
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.
Nivolumab is available in all parts of the UK.
You might have nivolumab after surgery to remove your bladder (cystectomy). This is called adjuvant treatment.
You can have it if:
- you have a high risk of your cancer coming back
- chemotherapy is not suitable for you
- your cancer has high levels of a protein called PD-L1
You might have atezolizumab if you have metastatic bladder. This means bladder cancer that has spread to other parts of your body.
You might also have it if your cancer has spread to nearby tissues or lymph nodes and your surgeon can’t remove it. Doctors call this inoperable locally advanced bladder cancer.
In England, Wales and Northern Ireland, you can have it:
- as your first treatment if chemotherapy isn't suitable, and your cancer has high levels of PD-L1
- as second line treatment if you have already had chemotherapy
In Scotland, atezolizumab is not available for people with bladder cancer. The Scottish Medicines Consortium (SMC) have not recommended it.
Avelumab is available in all parts of the UK.
You might have avelumab if you have metastatic bladder. This means bladder cancer that has spread to other parts of your body.
You might also have it if your cancer has spread to nearby tissues or lymph nodes and your surgeon can’t remove it. Doctors call this inoperable locally advanced bladder cancer.
You can have it if:
- you have had chemotherapy and your cancer has not grown or spread (progressed) during the treatment
You have it on its own after the chemotherapy. This is called maintenance treatment.
NICE has not approved pembrolizumab to treat bladder cancer. So it isn’t available in England, Wales or Northern Ireland.
The Scottish Medicines Consortium (SMC) have recommended pembrolizumab for people with bladder cancer.
In Scotland, you might have pembrolizumab if your bladder cancer has spread. You can have it for locally advanced cancer that has spread to nearby tissues or lymph nodes. Or for metastatic bladder. This means bladder cancer that has spread to other parts of your body.
You can have pembrolizumab if you have already had chemotherapy.
Having immunotherapy drugs
You have your treatment through a tube into your bloodstream.
You have the treatment through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.
You may need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.
Side effects of immunotherapy
Immunotherapy drugs can cause different side effects. Some of these can be serious. Your doctor or nurse will talk to you about this. Always tell them about any side effects you have and follow the advice they give you.
Choose a drug on our A to Z list to read about side effects and find out more about the drug.
Research into immunotherapy drugs for bladder cancer
Researchers are looking at different types of treatment for bladder cancer. These include many different types of immunotherapy drugs.
They are looking at these drugs on their own or combined with other treatments.
