Advanced bladder cancer, or stage 4 bladder cancer, is challenging to treat. However, new research is uncovering potential treatments and improving the long-term outlook for people with this disease.

The American Cancer Society estimates that 83,190 people will be diagnosed with bladder cancer this year. Around half of people are diagnosed with the disease in its early, most treatable stage.

To learn more, read about the latest studies and newest treatments for advanced bladder cancer below.

Chemotherapy, one of the first-line therapies for advanced bladder cancer, can come with a range of harsh side effects. Because of this, some people may want to take a break after treatment.

A large study presented in 2023 reported that nivolumab (Opdivo) is an effective postsurgery treatment for bladder cancer in patients with a high risk of recurrence. Researchers found that people receiving nivolumab had a median disease-free survival of 22 months, as opposed to 11 months among those receiving a placebo.

Research from 2020 found similar results — people who received infusions of the immunotherapy drug avelumab (Bavencio) before any sign of cancer recurrence had a median overall survival of more than 21 months, compared with 14 months among those who did not receive the drug.

In April 2019, the FDA approved the first treatment that specifically targets abnormal alterations in FGFR genes for the most common type of bladder cancer, metastatic urothelial carcinoma.

The drug erdafitinib (Balversa) blocks the activity of a group of proteins that can help bladder cancer cells grow in people with an FGFR gene mutation.

Clinical trial data found that erdafitinib effectively decreased tumor size in close to 40% of cases in which FGFR mutations were present and cancer progressed after or during chemotherapy.

A phase 3 trial further found that erdafitinib treatment significantly improved the overall survival rate among bladder cancer patients after initial PD-L1 therapy.

In December 2019, the FDA granted approval for a second targeted drug, enfortumab vedotin-ejfv (Padcev). It approved the drug for treating advanced urothelial carcinoma that didn’t improve after chemotherapy and immunotherapy.

Enfortumab vedotin is an antibody-drug conjugate, which means the medication has two connected parts: an antibody protein and a chemotherapy drug.

During treatment, the antibody part binds to a protein found on most bladder cancer cells. When this happens, it brings the chemotherapy directly to the cells, which helps fight the cancer.

Enfortumab and pembrolizumab combination

In December 2023, the FDA granted further approval to enfortumab in combination with pembrolizumab (Keytruda) for the treatment of advanced bladder cancer.

This combination treatment was found to have a significant impact on cancer progression.

In study participants undergoing enfortumab and pembrolizumab combination treatment, tumors stopped growing or shrank in 67% of cases, as opposed to 44% in those receiving platinum-based chemotherapy.

Furthermore, the cancer disappeared entirely in close to 30% of participants undergoing this combination therapy, as opposed to 12% undergoing chemotherapy.

A study published in The Lancet in June 2018 found that robotic surgery on bladder cancer was just as effective as traditional surgery. The study included 302 people with bladder cancer who were followed for 2 years after surgery.

A 2021 review supported the efficacy of robotic-assisted surgery but noted that further studies are necessary to confirm its efficacy in treatment.

Robotic surgery isn’t available at all hospitals, and it takes longer and costs more than traditional surgery. However, study participants who underwent robotic surgery had:

  • faster recovery times
  • less bleeding
  • shorter stays in the hospital

The findings could further help people with bladder cancer and their doctors make decisions about surgery.

In July 2018, the FDA changed the approved use of two immunotherapy drugs for advanced bladder cancer, pembrolizumab (Keytruda) and atezolizumab (Tecentriq).

These treatments had been approved in 2017 to treat advanced bladder cancer in people who can’t receive cisplatin, a chemotherapy drug, for health-related reasons.

However, atezolizumab has since been removed from use in the United States for bladder cancer treatment by its manufacturers. Pembrolizumab has since been approved for cancer treatment in combination with enfortumab.

Physical biopsies remain the gold standard in cancer diagnosis. However, these procedures are invasive and often costly.

A 2021 review has identified the potential benefit of DNA blood tests as a noninvasive diagnostic tool for urothelial cancer. Research published in 2020 also found that a test based on DNA in the blood had a 97.9% chance of finding whether a person had kidney cancer versus bladder cancer and showed promising signs in brain cancer diagnosis.

The blood test shows patterns of a certain type of chemical tag on DNA. Based on these patterns, the researchers used artificial intelligence to understand whether the research participants had cancer and where the cancer was located in the body.

Subsequent reviews have highlighted the use of DNA testing as a potentially important part of bladder and kidney cancer diagnosis but concluded that further research is necessary to assess and improve its efficacy.

While more progress is needed, advancements in treatments and prevention are helping improve the outlook for people with advanced bladder cancer.