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First-Line and Maintenance Treatment for Advanced Bladder Cancer

First-Line and Maintenance Treatment for Advanced Bladder Cancer

This article is for people with locally advanced or metastatic bladder cancer and their care partners, or anyone who wants to learn more about advanced bladder cancer. The goal of this activity is help patients engage in shared decision-making with their doctor about treatment for advanced bladder cancer.

You will learn about:

  • What advanced bladder cancer is

  • Treatment options for advanced bladder cancer, including first-line and maintenance treatment

  • Possible side effects of treatment

  • Questions to ask your doctor

All medicines listed in this activity may not be approved by the US Food and Drug Administration (FDA) for locally advanced or metastatic bladder cancer but are recommended by the National Comprehensive Cancer Network (NCCN).

Test Your Knowledge

What Is Advanced Bladder Cancer?

Advanced bladder cancer is cancer that's locally advanced or metastatic.

Most bladder cancers start in the cells lining the bladder. With locally advanced cancer, tumor cells have grown through the bladder wall and spread to nearby tissue or lymph nodes.

Metastatic bladder cancer is when cancer spreads (metastasizes) to lymph nodes and organs far from the bladder, such as the liver, bones, or lungs. For some people, bladder cancer can be metastatic when it's first found or diagnosed.

Treatment Goals

The goals of treatment for advanced bladder cancer are to shrink tumors (groups of cancer cells), slow cancer growth and spread, and help you have the best quality of life possible.

No one treatment is for everyone, so you will make a plan with your doctor that best fits your goals and individual needs. Be sure to talk to your doctor and healthcare team about your personal preferences for your treatment plan.

Treating Advanced Bladder Cancer

Which treatment your doctor recommends will depend on your cancer stage and where it has spread, treatment you had before and how well it worked, and your overall health and wishes.

Treatment that may be used can include:

  • Systemic therapy (treatment that affects the whole body) including chemotherapy (or "chemo"), immunotherapy, and targeted therapy

  • Chemoradiation that combines radiation therapy with chemotherapy

  • Supportive or palliative care

  • Joining a clinical trial

First-Line Treatment

The first treatment you get is called first-line, and there are several options that may be used alone or in combination.

For locally advanced bladder cancer, these can include chemoradiation and systemic therapy such as chemotherapy and immunotherapy.

The main treatment for metastatic bladder cancer is systemic therapy, such as chemotherapy, immunotherapy, and targeted therapy. Some people may also have surgery to remove tumors that have spread to other parts of the body.

Maintenance Treatment for Advanced Bladder Cancer

Depending on which first-line treatment you get and how well it works, your doctor may recommended maintenance treatment. Maintenance is given to help keep cancer from coming back after it has disappeared or is stable after first-line treatment.

Maintenance treatment can include immunotherapy.  Only people who took certain chemotherapy as first-line treatment and whose cancer did not progress may be eligible for maintenance. Your doctor will evaluate if it may be an option for you.

John talks about his personal journey with being diagnosed and treated for metatstatic bladder cancer.

Next Treatment Options

If first-line treatment doesn't work or stops working and the cancer progresses, your doctor may recommend second-line treatment next. For advanced bladder cancer this may include chemotherapy, immunotherapy, or targeted therapy.

You can also discuss with your doctor if you may be eligible to join a clinical trial, and supportive or palliative care to help with symptoms and any treatment side effects.

Possible Side Effects of Treatment

Different treatments can have different side effects. And the same side effect can mean something different, and happen to a different degree, depending on which treatment you're taking. Some may also be more severe for you depending on which treatment you're taking.

Side effects will be managed differently depending on which treatment caused them. So be sure to tell your doctor about all side effects you have -- even if they don't seem severe or bothersome -- and when you have them.

Possible Side Effects of Treatment (cont)

Side effects that may happen can include:

  • Fatigue (tiredness)

  • Muscle or bone pain

  • Nausea, vomiting, diarrhea, constipation, loss of appetite

  • Fever, infections

  • Trouble breathing

  • Itching, skin rash or dryness, hair loss

  • Changes in certain lab tests

  • Kidney problems

Certain medicines when given by infusion into a vein (IV) can sometimes cause a temporary severe reaction.

Not all side effects are listed in this activity. Ask your doctor, pharmacist, or healthcare team for a complete list.

Managing Side Effects

Before treatment, ask your doctor about which side effects can happen with each treatment. You may need to call your doctor right away for certain side effects with certain treatments. Be sure to ask when you should call them or go to the emergency room because of side effects.

Some side effects can go away on their own over time, while others may last longer. Your doctor may recommend adding a medicine before, during, or after treatment to help. Together, you can discuss ways to manage side effects.

Tracking and recording your symptoms and any side effects in a journal or diary can be helpful for when you talk with your doctor.

Questions to Ask Your Doctor

Questions you can ask your doctor about advanced bladder cancer treatment can include:

  • What treatments are available, and what are the goals?

  • How will I know if treatment is working?

  • What side effects can happen with what treatments, and how can we manage them?

  • Is there a clinical trial I might be eligible for?

  • How can I have the best quality of life possible?

  • What should I do if I feel stressed or depressed?

  • Where can I find more information and resources?

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Survey Questions


You have successfully completed the program: First-Line and Maintenance Treatment for Advanced Bladder Cancer.

View Additional Materials on this topic that you may find useful:

Patient Handout

Bladder Cancer

Bladder Cancer -- Information for Patients

Bladder Cancer Treatment

Bladder Cancer Advocacy Network (BCAN)

Bladder Cancer Treatments (BCAN)

Resources for Patients and Care Partners (BCAN)

Authors and Disclosures

Clinician Reviewer

Karen Badal, MD, MPH

Senior Medical Education Director, Medscape, LLC.

Disclosure: Karen Badal, MD, MPH, has disclosed the following relevant financial relationships:Owns stock, stock options or bonds from: Kallyope, Inc.


Anita A. Galdieri, PharmD, RPh

Associate Medical Education Director, Medscape, LLC.

Disclosure: Anita. A. Galdieri, PharmD, RPh, has disclosed no relevant financial relationships.


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