Bladder cancer is when cancer begins in your bladder. The American Cancer Society (ACS) estimates that there will be 81,180 new cases of bladder cancer in the United States in 2022. Bladder cancer is more common in men than in women.

There are several different treatment options available for bladder cancer. One of these is immunotherapy, a type of treatment that works to boost your immune system’s response to the cancer.

In this article, we take a closer look at immunotherapy for bladder cancer, the types of immunotherapy that are used, and how effective they are.

Immunotherapy is a type of cancer treatment that helps your immune system respond to cancer.

You may only think of your immune system in the context of protecting you from infections. However, it can also recognize and respond to cancer cells as well.

Despite this, cancer cells have ways to evade the immune system. This often includes mechanisms that make them less visible to immune cells. When immune cells can’t “see” a cancer cell, they can’t get rid of it.

This is where immunotherapy comes in. The goal of immunotherapy is to give your immune cells the boost that they need to detect and destroy cancer cells.

Immunotherapy is used for some types of bladder cancer. Whether it’s recommended for your bladder cancer in particular can depend on several other factors, such as:

  • the stage of the cancer
  • the size of the cancer
  • how quickly the cancer is growing
  • the genetic makeup of the cancer
  • which treatments have been used already, if any
  • whether the cancer has spread to other parts of the body
  • your age and overall health
  • your personal preferences

There are three different types of immunotherapy for bladder cancer. Let’s take a more detailed look at each of them now.


BCG is a type of intravesical therapy for bladder cancer. It’s an acronym that stands for Bacillus Calmette-Guerin. BCG is actually a type of bacteria that’s related to the bacterial species that causes tuberculosis.

BCG is injected into the bladder as a liquid using a catheter. It can then help to trigger an immune response. The immune cells that respond to the BCG can then go on to respond to the bladder cancer.

This type of immunotherapy is typically used for early-stage bladder cancers. These cancers are still small and have not grown much into surrounding bladder tissue. BCG may also be used after surgery to prevent cancer from coming back.

There are some side effects to be aware of with BCG treatment. Flu-like symptoms are common. You may also have frequent urination, a burning sensation around your bladder, or blood in your urine.

Immune checkpoint inhibitors

Immune checkpoints are systems that help to keep your immune system from attacking healthy cells in your body. However, immune checkpoint proteins on cancer cells can prevent the immune system from detecting them.

Immune checkpoint inhibitors work to block immune checkpoints from working as they should. This helps immune cells, specifically T cells, to find and destroy cancer cells.

All immune checkpoint inhibitors are given intravenously (via IV). Several immune checkpoint inhibitors can be used for bladder cancer:

Immune checkpoint inhibitors may be used when bladder cancer has spread into the bladder muscle wall, nearby lymph nodes, or even more distant tissues. It can also be used after surgery to help prevent the cancer from coming back.

There are several side effects associated with immune checkpoint inhibitors. These are:

Monoclonal antibodies

Monoclonal antibodies are manufactured antibodies that target specific aspects of cancer cells. When a monoclonal antibody binds to its target on a cancer cell, it marks that cell for destruction by the immune system.

The types of monoclonal antibodies used for bladder cancer are called antibody-drug conjugates. This is when a chemotherapy drug is attached to a monoclonal antibody. When the monoclonal antibody binds to its target, it delivers the chemotherapy drug directly to the cancer cell.

The monoclonal antibodies used for bladder cancer are called enfortumab vedotin (Padcev) and sacituzumab govitecan (Trodelvy). Like immune checkpoint inhibitors, these drugs are given via IV.

Monoclonal antibodies are typically used for more advanced bladder cancers. They may be recommended when other treatment combinations, typically involving chemotherapy and immune checkpoint inhibitors, have already been tried.

Some of the potential side effects of these monoclonal antibody treatments are:

  • fatigue
  • loss of appetite
  • digestive symptoms like nausea or vomiting, diarrhea, and constipation
  • skin rash
  • hair loss
  • infusion reactions

Immunotherapy can help to improve the outlook for bladder cancer. Let’s look at what some of the research says.


A 2018 study looked at BCG treatment for bladder cancer in 140 people. Study participants had high risk bladder cancer that had not yet spread into the bladder muscle.

After 15 years, researchers found that, compared with those who didn’t receive BCG treatment, people who did had a significantly reduced long-term risk of bladder cancer progression or recurrence.

However, a 2020 review points out that as many as 25% to 45% of people don’t benefit from treatment with BCG. Research is ongoing to help refine BCG treatment to improve its effectiveness.

Immune checkpoint inhibitors

The results of a clinical trial published in 2021 looked into the effectiveness of Opdivo after bladder cancer surgery. Half of the trial participants received Opdivo after their surgery while the other half received a placebo.

Compared with taking the placebo, taking Opdivo after surgery increased median disease-free survival by 10 months. The percentage of people surviving without cancer recurrence after 6 months was also higher for Opdivo (77%) than for placebo (62.7%).

Monoclonal antibodies

Monoclonal antibodies can also be beneficial for people with bladder cancer who’ve previously received other treatments. For example, in clinical trial results published in 2021, the efficacy of Padcev for bladder cancer was assessed.

Compared with chemotherapy, researchers found that Padcev significantly improved both overall survival and progression-free survival. They also noted that the incidence of side effects of both Padcev and chemotherapy were similar.

In addition to immunotherapy, there are also several other treatments that are used for bladder cancer. These may be used alone or in combination with other treatments, including immunotherapy:

  • Surgery. Surgery is a common treatment for bladder cancer. Several different types of procedure may be used, including:
    • transurethral resection, when thin surgical tools are inserted in the bladder and used to remove the cancer
    • partial cystectomy, which is when the part of the bladder containing the cancer is removed
    • radical cystectomy, when the entire bladder is removed
  • Chemotherapy. Chemotherapy uses drugs that affect the mechanisms that cancer cells use to grow and divide. In this way, it can kill cancers cells or slow down their growth.
  • Intravesical chemotherapy. Similar to BCG treatment, intravesical chemotherapy involves injecting chemotherapy drugs into the bladder via a catheter.
  • Radiation therapy. Radiation therapy uses high energy radiation to destroy cancer cells.
  • Targeted therapy. Targeted therapy drugs hone in on specific aspects of cancer cells, flagging them for destruction. In this way, their activity is less broad than chemotherapy drugs.

The outlook for bladder cancer depends on many different factors, such as:

  • the stage at diagnosis
  • how quickly the cancer is growing and spreading
  • the genetic makeup of the cancer
  • how the cancer responds to treatment
  • your age and overall health

The SEER database of the National Cancer Institute estimates the 5-year survival rates for cancers. This is the percentage of people with a specific type and stage of cancer who are alive after 5 years.

These are the 5-year relative survival rates for bladder cancer, according to the SEER database:

  • Overall: The overall 5-year relative survival rate for bladder cancer is estimated to be 77.1%.
  • In situ: When bladder cancer remains on the bladder lining and hasn’t invaded bladder muscle tissue, the relative 5-year survival is estimated to be 96%.
  • Localized: If bladder cancer has spread deeper into bladder tissue, but still remains localized to the bladder, the 5-year relative survival is estimated at 69.6%.
  • Regional: When bladder cancer has spread to nearby lymph nodes and tissues, the 5-year relative survival is estimated at 39%.
  • Distant: If bladder cancer has spread into more distant organs and tissues (metastasized), the 5-year relative survival is estimated to be 7.7%.

These estimates are based on a large number of people with bladder cancer over many years. They don’t reflect recent advances in treatment or individual factors like age and overall health. As such, use them as a guide and not as a rule.

Immunotherapy is one of the potential treatments for bladder cancer. It works by helping your immune system respond to cancer.

There are three types of immunotherapy used for bladder cancer. These are BCG, immune checkpoint inhibitors, and monoclonal antibodies. All three of these treatment types can provide benefits to people with bladder cancer.

Whether immunotherapy is used for bladder cancer depends on many factors. If immunotherapy is recommended for your bladder cancer, be sure to ask your care team about the various benefits and risks associated with it.