Immunotherapy for Bladder Cancer
for bladder cancer

Understanding bladder cancer

Bladder cancer was the first indication for which an immunotherapy was granted a FDA approval in 1990 for early stage bladder cancer.30 Since 2016, more immunotherapies have been approved, including several checkpoint inhibitors as both first and second line treatments in locally advanced or metastatic bladder cancer. This page features information on bladder cancer and immunotherapy for patients with late stage bladder cancer.

The bladder is a hollow organ in the pelvis. The main function of the bladder is to store urine. When the cell growth inside the lining of the bladder change and grow out of control a tumor may be formed.31

Bladder cancer is a common cancer in Hong Kong, with about 400 new cases in a year.32It is common among people aged between 55 and 70, with more male than female patients at a ratio of 3:1.32

Bladder cancer survival rates depend on many factors, including the type and stage of bladder cancer that is diagnosed. The general 5-year survival rate for people with bladder cancer is 77%; the overall 10-year survival rate is 70% and the overall 15-year survival rate is 65%.33If the bladder cancer has spread to the regional lymph nodes, the 5-year survival rate is 35%.40If it has spread to a more distant site of the body such as lungs, liver or bones, the 5-year survival rate is 5%.40

Bladder cancer symptoms34

Blood or blood clots
in the urine
Pain or burning
sensation during
Frequent urination
Feeling the need to
urinate many times
throughout the night
Difficulty in
initiating urination
Lower back pain on
one side of the body

Some of the symptoms of bladder cancer are identical to those of cystitis, bladder stone or kidney stone.32 People should visit a doctor to get diagnosed if they experience any of the above symptoms.

Types of bladder cancer

There are three main types of bladder cancer. They are named after the cell type in which the cancer first develops.

Urothelial carcinoma
This type of cancer starts in the urothelial cells that line the inside of the bladder and found in the urinary tract. It accounts for the majority, about 90%, of all bladder cancers.31
Squamous cell carcinoma
This type of cancer starts in the thin, flat cells in the lining of the bladder. It accounts for about 4% of all bladder cancers.31
This cancer develops from the glandular cells of the bladder. It accounts for about 2% of all bladder cancers.31

Bladder cancers are also often described based on how far they have invaded into the wall of the bladder:

Non-muscle invasive bladder cancer
Cancer cells are in the inner lining (the transitional epithelium) and have not grown into the deeper muscle layers of the bladder. They are considered as early stages of the cancer.35
Muscle-invasive bladder cancer
These cancers have grown into deeper layers of the bladder wall. They are more likely to spread and are harder to treat.35
Metastatic bladder cancer
These cancers have spread to other parts of the body, such as the lungs, the liver, or the bones.41

Bladder cancer staging

Here are the main stages of bladder cancer.36

Stage 0 This is an early stage cancer which includes non-invasive papillary urothelial carcinoma and carcinoma in-situ. In both cases the cancer is found only on the inner lining and has not invaded or spread to other layers in the bladder wall.
Stage I The cancer has grown through the inner lining of the bladder and into the lamina propria. It has not spread to the thick layer of muscle in the bladder wall, lymph nodes or other organs.
Stage II The cancer has spread into the thick muscle wall of the bladder but has not reached the fatty tissue surrounding the bladder or spread to the lymph nodes or other organs. It is also called muscle-invasive cancer.
Stage III The cancer has spread throughout the muscle wall to the fatty layer of tissue surrounding the bladder (perivesical tissue), or the prostate, uterus, vagina or regional lymph nodes. (Muscle-invasive bladder cancer is classified as stage 3 bladder cancer)
Stage IV The tumor has spread into the pelvic wall or abdominal wall, or the cancer has spread to lymph nodes outside of the pelvis or to other parts of the body. (Metastatic bladder cancer is classified as Stage 4 bladder cancer)

Grading bladder cancer36

The biopsy results will also tell the grade of bladder cancer, which tells how much cancer cells look like healthy cells. Knowing the grade helps predict how likely the cancer is to recur, grow and spread, and help doctors plan treatment.

Low grade: This type of cancer may recur.
High grade: This type of cancer is more likely to recur, grow and spread.

Bladder cancer treatment

Treatment options are based on a patient’s cancer type and stage, location, molecular characteristics, and his/her overall health. The most common treatments for bladder cancer are surgery, chemotherapy, radiation therapy, and immunotherapy.

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. Common surgery for bladder cancer include: transurethral removal of bladder tumor, cystectomy and lymph node dissection, and urinary diversion.37
Chemotherapy uses drugs to stop cancer cells’ ability to proliferate. The two types of chemotherapy used to treat bladder cancer include: intravesical chemotherapy and systemic chemotherapy.37
Radiation therapy
Radiotherapy is the use of high-energy X-rays or other particles to destroy cancer cells. It may target the cancer from outside of the body or can be placed inside as implants to help attack the cancer. Radiotherapy is usually not used by itself as a primary treatment for bladder cancer, but it may be given in combination with chemotherapy which is known as chemoradiotherapy.37
Radiation therapy
These new treatments work by boosting body's own natural defenses to fight the cancer. Immunotherapy drugs used to treat bladder cancer include: Bacillus Calmette-Guerin (BCG), interferon, and immune checkpoint inhibitors37

We focus on immune checkpoint inhibitors for late stage bladder cancer in this webpage.