Chemotherapy & Radiation
Chemotherapy is a drug or a combination of drugs that kill cancer cells wherever they are in the body. Memorial Sloan Kettering’s disease management team includes medical oncologists who specialize in chemotherapy for bladder cancer.
Before beginning chemotherapy, patients undergo a comprehensive evaluation to assess how well they will likely tolerate certain treatments. This includes a careful consideration of clinical aspects — such as kidney, heart, and liver function, age, and general health condition — but also takes into account characteristics of the tumor based on analysis by our pathologists.
This critical data enables our oncologists to tailor the optimal chemotherapy regimen that will treat the cancer safely while preserving the best quality of life.
Minimizing Side Effects
Recent refinements in chemotherapy drugs, along with advances in our approaches to supportive care, have greatly reduced or even eliminated many of the side effects that people typically experienced in years past.
Our medical oncologists understand the subtleties of various chemotherapy regimens and will personalize your treatment to make sure that it is as effective as possible while maximizing your quality of life. For example, specific chemotherapy treatments have been developed for use in older patients so that they experience fewer side effects.
Chemotherapy before Surgery (Neoadjuvant Therapy)
If you have muscle-invasive bladder cancer that requires removal of the bladder, you will likely receive chemotherapy before the procedure to eliminate cancer cells that may have spread to other organs, a treatment known as neoadjuvant chemotherapy. Large clinical studies have shown that receiving chemotherapy before surgery for bladder cancer improves cure rates and long-term survival; this is now the standard of care for our patients who are candidates for this approach.
At Memorial Sloan Kettering, we place a very high priority on ensuring that our patients complete their neoadjuvant chemotherapy efficiently — in about 12 weeks — and are ready for surgery four to six weeks after completing chemotherapy.
This shortened time frame has been shown to produce better results. We are able to ensure this timeliness through the coordination of our medical oncologists, bladder surgeons, and highly specialized nurses — all of whom are located in the same building.
The members of your team also all have access to your clinical information, including pathology and lab tests, scan results, medications, and more, immediately available at all times. Most institutions that treat bladder cancer take much longer — often twice as long — to get their patients through chemotherapy and surgery due to a lack of coordinated care and access to timely and critical patient information.
Chemotherapy after Surgery (Adjuvant Therapy)
Some patients who do not receive chemotherapy before surgery might benefit from receiving it afterward if their cancer has spread beyond the bladder wall or to surrounding lymph nodes or organs (stage IV).
Together with your doctor, we use a powerful bladder cancer prediction tool, called a nomogram, to help decide your best treatment plan following surgery. We developed this tool, which uses specific information about your cancer to predict the five-year risk of recurrence — a key factor in deciding whether additional treatment after surgery is likely to be beneficial.
Chemotherapy and Novel Agents for Metastatic Bladder Cancer
In some people, bladder cancer has already spread so extensively to other organs that surgery to remove the primary tumor would provide no benefit. In these situations we typically recommend treatment with chemotherapy designed to shrink the tumors.
At Memorial Sloan Kettering, standard treatment for metastatic bladder cancer includes both widely accepted chemotherapeutic regimens as well as new approaches that are being tested in clinical trials. Our physicians are continuously investigating and refining new chemotherapy combinations and regimens to provide better outcomes for our patients.
In addition, we are conducting clinical trials investigating the effectiveness of novel drugs for bladder cancer. These trials aim to improve the effectiveness of standard therapy and include agents that directly attack the tumor cells as well as drugs that attack cancer cells indirectly by reducing the blood vessels that support their growth.
For patients with metastatic or recurrent bladder cancer, we can analyze biopsy samples to look for specific genetic mutations in the tumor. Knowing which mutations are present in (or absent from) a tumor can help determine which clinical trial will most likely benefit patients. Some new drugs have proven to be very effective at targeting specific genetic alterations in tumors.
For example, one clinical trial at Memorial Sloan Kettering is testing a drug called BKM120 in patients whose metastatic bladder cancer has a genetic alteration in a molecular signaling pathway called PI3K, which is activated in some cancers. For this group of patients, BKM120 has shown promise in preventing cancer growth and progression.
Numerous other clinical trials are under way that test new drugs tailored toward people with specific genetic mutations.
As part of your treatment, you may also receive radiation before surgery to shrink the cancer or after surgery to destroy any remaining cancer cells. Radiation may also be used if you cannot have surgery.
Our radiation therapists use sophisticated techniques to give you the best therapeutic outcomes while minimizing damage to normal tissue. One such approach, called intensity-modulated radiation therapy (IMRT), enables us to deliver pencil-thin radiation beams of varying intensity with extreme precision and greater safety than conventional radiation approaches. The uneven intensity conforms to specific tumor shapes and sizes, reducing the dosage of radiation to healthy tissues and possibly the side effects of treatment.
Or you may receive an enhanced form of IMRT known as image-guided radiation therapy (IGRT). This approach enables our radiation oncologists to incorporate real-time image guidance, so they can make adjustments in delivering the radiation beam with even more precision.
Another form of radiation called brachytherapy is sometimes given during surgery to remove the cancer. In this technique, a radiation therapist works with the surgeon to identify areas where cancer cells may be left behind after a tumor is removed. We deliver powerful radiation through catheters that are placed directly on the at-risk tissue. Normal tissue that is especially radiation-sensitive can be shielded and protected. Once the procedure is completed, all radiation-related materials are removed and the operation continues.