The word “metastatic” in the term “metastatic bladder cancer” means that the cancer has spread to different parts of the body, and this spreading makes the cancer more difficult to treat. Oncologists (cancer specialists) use many medications to treat bladder cancer that has spread. Studies show that some new treatments help people with metastatic bladder cancer live longer.

This article will cover the available treatments for metastatic bladder cancer, including new immunotherapies and targeted therapies. It will also cover the prognosis (outlook) and life expectancy with stage 4, or metastatic, bladder cancer. While studies can’t predict your exact outlook, they help your doctor choose the best treatments for your individual case of bladder cancer.

Understanding Metastatic Bladder Cancer

“Metastatic” is the medical term for cancer that has spread away from the primary (main) tumor to other parts of the body. When cancer metastasizes, it usually moves into nearby tissues and organs first. The lymph nodes are tiny immune system structures found throughout your body. Once bladder cancer cells spread to the lymph nodes, they can travel to other organs.

“Metastatic” is the medical term for cancer that has spread away from the primary (main) tumor to other parts of the body.

The most common places for bladder cancer to spread, besides lymph nodes, are the:

• Liver
• Lungs
• Bones
• Other parts of the urinary tract
• Reproductive tract, including the uterus, vagina, or prostate

Some factors affect your risk of metastasis. For example, muscle-invasive bladder cancer is more likely to spread. This is because the cancer has already grown into the deeper layers of the bladder wall.

Treatments for Metastatic Bladder Cancer

Since metastatic bladder cancer has spread throughout the body, local treatments likely won’t work. Surgery removes tumors in the bladder. However, systemic therapies (treatments that affect the whole body) are usually preferred. Your options may include chemotherapy, immunotherapy, and targeted therapy. Doctors use combinations of these medications to shrink metastatic bladder cancer tumors and stop their progression.

Some people with metastatic bladder cancer may be eligible to join clinical trials. These large studies test how well new drugs work. Your doctor may suggest a clinical trial if your cancer is difficult to treat.

Chemotherapy

Chemotherapies are drugs that kill fast-growing cells. Cancer cells grow much faster than healthy, normal cells. These drugs work by blocking different parts of the cell cycle. This is the process of how cells grow and divide into new cells.

According to the National Cancer Institute (NCI), doctors use many chemotherapies for metastatic bladder cancer. Studies show that certain combinations help people live longer with this cancer. Examples include:

• Cisplatin, methotrexate, and vinblastine (CMV)
• Dose-dense (more frequent) MVAC
• Gemcitabine and cisplatin
• Methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC)

While chemotherapy works well to treat cancer, it has some side effects. The drugs can’t tell the difference between cancer cells and healthy cells. Some healthy cells grow quickly — like certain blood cells and hair follicles. This is why people taking chemotherapy drugs lose their hair and get sick easier.

Other side effects of chemotherapy are:

• Nausea and vomiting
• Changes in your appetite
• Fatigue or tiredness
• Mouth and tongue sores
• Bruising and bleeding easily

Immunotherapy

Immunotherapy drugs help boost your immune system so it can more effectively recognize and destroy cancer cells. There are several types of immunotherapy — like immune checkpoint inhibitors (ICIs) — for bladder cancer.

ICIs work by blocking proteins found on cancer and immune cells. These proteins normally help “turn off” the immune system. By blocking the proteins, immune cells can find and destroy cancer cells.

As treatments improve, so does the outlook with metastatic bladder cancer.

The U.S. Food and Drug Administration (FDA) has approved many immunotherapies for metastatic bladder cancer. They include:

• Atezolizumab (Tecentriq)
• Avelumab (Bavencio)
• Nivolumab (Opdivo)
• Pembrolizumab (Keytruda)

Doctors prescribe immunotherapy alone or together with chemotherapy or antibody-drug conjugates (ADCs). You may receive immunotherapy alone if you have had chemotherapy treatment before or you’re now ineligible for it.

The side effects of immunotherapy depend on the medication and if it’s combined with other drugs. ICIs may cause:

• Rashes
• Diarrhea or constipation
• Nausea
• Loss of appetite
• Cough
• Joint and muscle pain

Targeted Therapy

Targeted therapy works by blocking specific proteins on cancer cells. This leaves healthy cells alone. Only certain people can take targeted therapies, because bladder cancer cells need specific gene mutations (changes) to target.

Erdafitinib (Balversa) is an FDA-approved therapy for metastatic bladder cancer. It targets the fibroblast growth factor receptor (FGFR). This group of proteins helps bladder cancer cells grow and divide. The NCI notes that around 1 in 5 cases of metastatic urothelial carcinoma have FGFR mutations.

Erdafitinib blocks FGFR to shrink tumors. The drug is usually given to people whose tumors still grow even after other treatments. Targeted therapies usually have fewer side effects compared to chemotherapy. In studies, side effects of erdafitinib have included:

• Mouth sores
• Changes in taste
• Dry mouth
• Diarrhea
• Loss of appetite

Antibody-Drug Conjugates

Researchers have developed new ways to deliver toxic chemotherapy drugs to tumors. Antibody-drug conjugates use chemotherapy attached to an antibody. Lab-made antibodies are great at targeting cancer cells to shrink tumors. This is because they recognize specific patterns on cancer cells.

In an ADC, the antibody finds and targets the cancer cells. The chemotherapy then destroys the cancer cells to shrink the tumor. ADCs leave healthy cells untouched, so they have fewer side effects compared to chemotherapy.

The FDA approved enfortumab vedotin (Padcev) in 2019 to treat metastatic bladder cancer in people who were treated for metastatic urothelial carcinoma but did not respond to previous treatments. This treatment has now been approved for use in combination with pembrolizumab as the preferred therapy option to treat metastatic bladder cancer.

Common side effects of enfortumab vedotin include:

• Hair loss
• Fatigue or tiredness
• Changes in your ability to taste
• Loss of appetite
• Rashes
• Peripheral neuropathy (damage to the nerves in your hands and feet)

In some serious cases, ADC treatment can also lead to low levels of immune cells and a fever.

Prognosis and Life Expectancy With Metastatic Bladder Cancer

Doctors use cancer statistics collected over several years to predict a person’s prognosis. One common statistic is known as the five-year relative survival rate. This estimates the percentage of people with bladder cancer alive after five years compared to people in the general population.

According to the American Cancer Society, the five-year relative survival rate of metastatic bladder cancer is 8 percent. This means that a person with this cancer is 8 percent as likely to be alive after five years compared to someone without cancer.

While these statistics sound scary, it’s important to remember that they can’t predict your exact outlook. Researchers have discovered many new treatments to improve life expectancy with bladder cancer. The American Cancer Society (ACS) notes that survival statistics are at least five years old. As treatments improve, so does the outlook with metastatic bladder cancer.

For example, studies show that combining chemotherapy and immunotherapy improves overall survival, while combining immunotherapy and ADCs increases it even more. This refers to how many people are alive after a certain treatment. One report found that people receiving chemotherapy with nivolumab lived longer than those getting chemotherapy alone.

Many survival rates for bladder cancer also don’t account for a person’s overall health or how well their cancer treatment works. These factors play a major part in influencing outlook. Your oncologist and cancer care team can help you better understand your individual prognosis.

Talk With Others Who Understand

MyBladderCancerTeam is the social network for people with bladder cancer and their loved ones. On MyBladderCancerTeam, members come together to ask questions, give advice, and share their stories with others who understand life with bladder cancer.

Are you living with metastatic bladder cancer? What treatments have you tried? Share your experiences in the comments below, or start a conversation by posting on your Activities page.