Bladder cancer

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Immunotherapy for bladder cancer

Some people with bladder cancer have immunotherapy. Immunotherapy helps to strengthen or restore the immune system’s ability to fight cancer.

You may have immunotherapy to:

  • kill bladder cancer cells
  • strengthen your immune system
  • stop bladder cancer cells from growing and spreading
  • help keep the cancer from coming back after it has already been treated (called maintenance therapy)
  • control symptoms of bladder cancer


Intravesical immunotherapy

Intravesical immunotherapy is when the drug is placed directly into the bladder. The doctor passes a tube (catheter) through the urethra and into the bladder. An immunotherapy drug is given through the tube into the bladder. The drug is left in the bladder for 1 to 2 hours to give it time to work.

The most common drug used for intravesical immunotherapy is bacillus Calmette-Guérin (BCG). BCG is the same bacteria used to vaccinate against tuberculosis. It contains live, but weak, bacteria that gets your immune system to kill cancer cells in the bladder.

Intravesical immunotherapy may be used to treat stage 0 and stage 1 bladder cancers that are classified as intermediate risk or high risk. It is given after a transurethral resection of bladder tumour (TURBT), once a week for 6 weeks (called induction therapy). To lower the risk of side effects, intravesical immunotherapy is usually started a few weeks after a TURBT.

If there is no cancer remaining after the 6 weeks, more treatment is often given as maintenance therapy. It is given once a week for 3 weeks every 3 to 6 months for up to 3 years.

If cancer still remains after the 6 weeks, another 6 weeks of intravesical immunotherapy is usually offered.

Intravesical immunotherapy is also used to treat bladder cancer that comes back only in the inner lining of the bladder.

Immune checkpoint inhibitors

Immune checkpoint inhibitors are a type of immunotherapy that uses drugs called monoclonal antibodies. The immune system normally stops itself from attacking normal cells in the body by using specific proteins called checkpoints, which are made by some immune system cells. Bladder cancer cells sometimes use these checkpoints to avoid being attacked by the immune system. Immune checkpoint inhibitors block the checkpoint proteins so immune system cells (called T cells) can attack and kill the cancer cells.

An immune checkpoint inhibitor may be offered as a second-line therapy for advanced or metastatic bladder cancer that:

  • is still growing during or after chemotherapy that includes cisplatin
  • comes back within 12 months of finishing chemotherapy

The immune checkpoint inhibitors used for bladder cancer target the PD-1 or PD-L1 checkpoint protein. They are:

  • pembrolizumab (Keytruda) – most commonly used
  • durvalumab (Imfinzi)
  • atezolizumab (Tecentriq)
  • avelumab (Bavencio)

The drug is given through a needle into a vein (intravenous infusion) once every 2 or 3 weeks until the disease progresses or the side effects outweigh the benefits of having the treatment.

Side effects

Side effects can happen with any type of treatment for bladder cancer, but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.

Side effects of immunotherapy will depend mainly on the type of drug, the dose, how it’s given and your overall health.

Intravesical BCG may cause these side effects:

  • a need to urinate (pee) more often than usual (frequent urination)
  • an intense need to urinate (urgent urination)
  • burning during urination
  • flu-like symptoms, such as fever, chills, fatigue and an achy body
  • loss of appetite

Immune checkpoint inhibitors may cause these side effects:

You will have blood tests frequently to check how your body is reacting to immunotherapy. If you have inflammation, your doctor may give you steroids.

Report side effects



Information about specific cancer drugs


Questions to ask about immunotherapy


monoclonal antibody



second-line therapy

Treatment given for a condition or disease (such as cancer) when the first-line therapy (the first or standard treatment) does not work or stops working.

Also called secondary therapy or secondary treatment.