Chemotherapy is the administration of drugs to treat bladder cancer. This chemotherapy in bladder cancer can be administered in two modes: intravenous chemotherapy and systemic chemotherapy.
In this type of treatment, the active molecule is introduced directly into the bladder.
This type of chemotherapy is only performed in the early stages of superficial bladder cancer.
This is an intravenous instillation therapy.
Treatments are then administered orally, as tablets, or injected intravenously or intramuscularly.
The active molecules pass through the bloodstream and bathe the entire human body.
These treatments are called systemic chemotherapy.
These systemic chemotherapies can fight and destroy cancer cells at a distance from the initial tumour.
When is chemotherapy indicated?
Chemotherapy may be indicated:
- Before performing surgery to try to reduce the volume of the initial tumor to reduce the risk of recurrence. This administration of chemotherapy prior to surgery is called neo-adjuvant chemotherapy.
- After surgery or sometimes after radiotherapy. It’s adjuvant chemotherapy. The goal of adjuvant chemotherapy is to eliminate any remaining cancer cells after the other treatments, which are too small to be seen. This reduces the risk of subsequent cancer recurrence.
- For people treated with radiation therapy, to sensitize the tumour to the effect of radiation.
- As a primary treatment for advanced bladder cancers, such as those that have metastasized to different parts of the body and for which surgery is no longer indicated because the disease is not local.
What types of drugs are used to treat bladder cancer?
The different chemotherapy molecules can be used alone or in combination, depending on the extent of tumour extension, the patient’s general condition and comorbidities. There are other factors that are also taken into consideration.
When chemotherapy is administered in conjunction with radiation therapy in a concomitant radiochemotherapy regimen, the drugs usually used are:
- The Cisplatin;
- Cisplatin and Fluorouracil (5-FU);
- Mitomycin associated with 5-FU.
When chemotherapy is used alone without irradiation, the usual combinations include:
- Gemcitabine and Cisplatin,
- Methotrexate, Vinblastine, Doxorubicin (Adriamycin), and Cisplatin (MVAC protocol).
- Cisplatin, Methotrexate and Vinblastine (CMV protocol).
- Carboplatin associated with other molecules such as Paclitaxel or Docetaxel. This chemotherapy is indicated in patients with impaired renal function.
In some patients, the side effects of poly-chemotherapy are too heavy to bear. These people will need to undergo mono-chemotherapy, such as the use of Gemcitabine alone or Cisplatin.
Other molecules used in mono-chemotherapy in bladder cancer are:
Carboplatin, Docetaxel, Paclitaxel, Doxorubicin, 5-Fluorouracil (5-FU), Methotrexate, Vinblastine, Ifosfamide, Pémétrexed.
Chemotherapy protocols usually involve several cycles. Between 2 cycles of chemotherapy, there is a rest period that allows the body to recover.
Usually, each cycle takes place over a few weeks.
Most bladder cancers are urothelial cancers, transitional cell cancers, but there are other types of cancers including squamous cell cancer, adenocarcinoma and small cell cancer.
Chemotherapy in these rare forms of bladder cancer can sometimes involve different molecules than those mentioned above.
Side effects of chemotherapy
Chemotherapy drugs target electively at cells that are in rapid division mode.
This is why they are particularly effective against cancer cells. However, healthy cells in the body, especially in the bone marrow where there are many stem cells that cause blood cells that are also in rapid division, or cells in the buccal lining or intestines, or cells in hair follicles that divide rapidly, are likely to be affected by the effects of chemotherapy, which can lead to the production of undesirable side effects.
Adverse side effects of chemotherapy depend on the type of chemotherapy and the dose at which the drugs are administered, as well as the duration of treatment.
In the concomitant radiochemotherapy regimen, the adverse effects of radiotherapy and chemotherapy tend to potentiate.
Adverse side effects of chemotherapy are usually side effects:
- Nausea and vomiting,
- Loss of appetite,
- Hair loss,
- Oral stomatitis,
- Diarrhea and constipation,
- Increased risk of infection due to the significant decrease in the body’s white blood cells,
- Increased risk of bleeding due to decreased platelet counts,
- Fatigue in relation to anemia caused by a decrease in red blood cell count.
These undesirable side effects usually subside after the end of treatment.
There are opportunities to compensate for these unwanted side effects. For example, there are treatments to reduce nausea and vomiting.
Other molecules used in chemotherapy may cause less frequent adverse reactions. For example, treatments with CISPLATINE CARBOPLATINE, DOCAETAXEL and PACLITAXEL may cause neurological damage.
Symptoms mainly affect the extremities of the hands and feet, with pain, burning or electrical shock sensations, increased sensitivity to heat and cold, and decreased muscle strength at this level.
These disorders are part of peripheral neuropathy.
Some chemotherapy medications increase the risk of later inducing leukemia. However, this circumstance is rare.