How Is Metastatic Bladder Cancer Treated?

Metastatic bladder cancer is generally quite difficult to treat. Current treatment for bladder cancer that has spread outside of the bladder is aggressive chemotherapy. Most often, a combination of four drugs is given. These medications are abbreviated M-VAC, which stands for methotrexate, vinblastine, Adriamycin (also called doxorubicin), and cisplatin; 60% to 70% of tumors will respond to this regimen, although complete responses are only seen in about 30%. Of the 30% who achieve a complete response, almost all will eventually relapse.

This type of chemotherapy may be difficult for some patients to tolerate, and the number of patients who do not respond is significant. Researchers have there-fore had great interest in devising a more effective, better tolerated regimen since M-VAC was first used in the 1980s, but it still remains the gold standard.

In recent years, however, the duration of chemotherapy has been decreased from 4 weeks to 2 weeks with less toxic side effects for the patient and improved response rates of 50% and higher. Please note this is response rate, meaning slowing down the growth and/or shrinking the tumor metastases, but not curing one of the metastatic cancer. Another chemotherapy regimen that is being used is that of gemcitabine and cisplatinum.

This combination is less toxic than M-VAC and has similar response rates. Because the tolerance is so much better, most patients are now treated with gemcitabine/ cisplatinum, even though M-VAC might have slightly better success rates. Overall, the average survival of a patient being treated for metastatic bladder cancer is about 14 months.

Recently, some patients with metastatic bladder cancer have been treated with a combination of chemotherapy and surgery. The metastatic tumor was completely removed by surgery, with chemotherapy given in addition. Early results of this approach are promising, but the treatment is only being done as part of a clinical trial until a definite improvement can be shown.