Intravesical
Immunotherapy
and Chemotherapy

Uro-Oncology - Bladder Cancer

Overview

Intravesical chemotherapy and immunotherapy are two localised treatment methods for bladder cancer. These therapies involve directly administering agents into the bladder through a catheter, targeting cancer cells while minimising systemic side effects. Intravesical therapy is typically used for non-muscle-invasive bladder cancer (NMIBC) to reduce recurrence and progression.

While intravesical immunotherapy and intravesical chemotherapy are both treatments administered directly into the bladder, they are not the same. Intravesical immunotherapy uses the body’s immune system to fight cancer, typically using agents to stimulate an immune response against bladder cancer cells. Intravesical chemotherapy, on the other hand, involves the direct application of anti-cancer drugs into the bladder to kill cancer cells. Both aim to treat bladder cancer locally, but their mechanisms of action differ significantly.

Procedure Details

Intravesical Immunotherapy 

  • Agent: The most commonly used agent is Bacillus Calmette-Guérin (BCG). 
  • Mechanism: BCG stimulates the immune system to attack cancer cells.
  • Administration: The treatment is usually done once a week for six weeks, known as induction therapy, followed by maintenance therapy, which may last for several months to years.
  • Process: A catheter is inserted into the bladder, and the BCG solution is instilled. Patients are instructed to hold the solution in the bladder for about two hours before voiding.

Intravesical Chemotherapy 

  • Agents: Commonly used agents include mitomycin C, gemcitabine, and epirubicin.
  • Mechanism: These drugs kill or inhibit the growth of cancer cells.
  • Administration: Similar to BCG, chemotherapy agents are instilled into the bladder through a catheter. The treatment schedule varies depending on the drug and protocol.
  • Process: Patients are instructed to retain the solution in their bladder for a specific duration before emptying/urinating.

Why It’s Done

  • Localised Treatment: The primary advantage of intravesical therapy is its local action. Direct administration of the drug into the bladder achieves higher concentrations at the tumour site with minimal systemic absorption, thereby reducing overall side effects.
  • Effectiveness: BCG immunotherapy has a high success rate in reducing NMIBC recurrence and progression. Chemotherapeutic agents are effective in killing cancer cells and preventing recurrence.
  • Preservation of Bladder: Intravesical therapies often help to avoid or delay the need for more invasive treatments, such as a radical cystectomy.

Potential Risks

Common Side Effects:  

  • Local Irritation:  Both BCG and chemotherapy can irritate the bladder lining, leading to symptoms like frequent urination, urgency, and a burning sensation.
  • Hematuria: Presence of blood in the urine 
  • Flu-like Symptoms: BCG can cause systemic effects such as fever, chills, and malaise, mimicking flu symptoms.
  • Allergic Reactions: In rare instances, patients may experience allergic reactions to the instilled agents.

Serious Complications:

  • Severe Cystitis: Intravesical chemotherapy can cause prolonged bladder inflammation,  leading to severe cystitis.
  • Systemic Infection: Although rare, BCG can cause a disseminated infection, necessitating the use of anti-tuberculosis medications.
  • Bladder Contracture: Long-term inflammation can lead to bladder contracture, reducing its capacity.

Recovery and Outlook

Recovery:

Immediate Aftercare: Patients are usually able to go home shortly after the procedure. They are advised to drink plenty of fluids to flush out the bladder.

Activity: Patients can typically resume normal activities immediately, but strenuous activities should be avoided for 24 to 48 hours.

Follow-Up: Regular cystoscopic evaluations are necessary to monitor the bladder for any signs of cancer recurrence. The frequency of follow-ups depends on the individual’s risk factors and response to treatment.

Outlook:

Effectiveness: Intravesical BCG is effective in approximately 70% of patients with NMIBC, significantly reducing the risk of recurrence and progression. Chemotherapy is also effective, though the response rates may vary.

Long-Term Management: For some patients, maintenance therapy is required. BCG maintenance therapy, for instance, can continue for several years to sustain its benefits.

Survival Rates: The prognosis for patients with NMIBC undergoing intravesical therapy is generally favourable, especially when the disease is detected early and treated promptly.

Look-Term Outlook

  • Intravesical therapy has been effective in reducing recurrence rates in NMIBC.
  • Regular follow-up cystoscopies are essential to monitor the bladder for any signs of recurrence.
  • Adherence to the maintenance therapy schedule can significantly impact long-term outcomes

When to Call the Doctor

Patients should contact their healthcare provider if they experience any of the following:

  • Severe or Prolonged Symptoms: Report any persistent pain, severe urinary symptoms, or significant bleeding. 
  • Signs of Infection: Fever, chills, or a feeling of malaise may indicate a urinary tract infection or, in rare cases, a systemic infection from BCG.
  • Allergic Reactions: Symptoms such as rash, difficulty breathing, or swelling require immediate medical attention.
  • Unresolved Side Effects: If side effects like bladder irritation do not improve or worsen, it’s important to seek medical advice.

Summary

Intravesical chemotherapy and immunotherapy represent cornerstone treatments for NMIBC, offering a targeted approach with the potential to preserve bladder function and improve long-term outcomes. Through careful management of side effects and consistent follow-ups, patients can achieve significant benefits from these therapies. Reach out to Assure Urology and Robotic Centre if you are seeking intravesical immunotherapy or chemotherapy as part of your bladder cancer treatment plan.

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