Bladder Cancer Drug Summary

Last updated: 26 January 2026
Reviewed by

Cancer Immunotherapy

Drug Dosage Remarks
Atezolizumab 840 mg IV infusion for 60 minutes every 2 weeks or
1,200 mg IV infusion for 60 minutes once every 3 weeks or
1,680 mg IV infusion for 60 minutes
every 4 weeks until disease progression or unacceptable toxicity
If first dose is tolerated, all subsequent
infusions may be administered over
30 minutes		 Adverse Reactions
  • GI effects (diarrhea, nausea/vomiting, dysphagia, colitis, abdominal pain, constipation, intestinal obstruction); Dermatologic effects (rash, pruritus); Endocrine effects (hypothyroidism, hyperthyroidism); Respiratory effects (dyspnea, cough); Hepatic effect (increased alanine aminotransferase [ALT] and aspartate aminotransferase [AST]); Metabolic effects (hypokalemia, hyponatremia); Other effects (fatigue, asthenia, decreased appetite, arthralgia, influenza-like illness, infusion-related reaction, hypersensitivity, musculoskeletal pain, hypoxia, hypotension)
Special Instructions
  • Do not administer as an IV push or bolus
  • Monitor ALT, AST and bilirubin, thyroid function prior to and periodically during treatment
  • Monitor patients for signs and symptoms of immune-related pneumonitis or interstitial lung disease; hepatitis; colitis or diarrhea; thyroid disorders, adrenal insufficiency, and type 1 diabetes mellitus (DM) including diabetic ketoacidosis
Avelumab 800 mg IV infusion for 60 minutes once every 2 weeks until disease progression or unacceptable toxicity Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, abdominal pain, constipation); Renal effects (urinary tract infection [UTI], increased creatinine, renal failure); Resp effects (dyspnea, cough); Dermatologic effects (rash, pruritus); Hematologic effects (anemia, lymphopenia); Metabolic effects (increased alkaline phosphatase [ALP], lipase, AST, amylase, bilirubin, γ-glutamyl transferase, hyponatremia, hyperglycemia, hyperkalemia); Other effects (fatigue, hypertension, infusion-related reactions, peripheral edema, pyrexia, decreased weight, decreased appetite, musculoskeletal pain)
Special Instructions
  • Use with caution in patients at risk of immune-related adverse reactions
  • Monitor for changes in liver function, serum creatinine, for signs and symptoms of infusion-related reactions, immune-related pneumonitis, hepatitis, colitis, thyroid disorders, adrenal insufficiency, and type 1 DM
Sacituzumab govitecan 10 mg/kg IV infusion for 3 hours weekly on days 1 and 8 of continuous
21-day treatment cycles until disease
progression or unacceptable toxicity
If first dose is tolerated, subsequent infusions may be administered
over 1-2 hours		 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, decreased appetite, abdominal pain); Other effects (fatigue, neutropenia, rash)
Special Instructions
  • Do not administer as IV push or bolus
  • Do not administer if absolute neutrophil count (ANC) <1,500 cells/mm3 on day 1 or <1,000 cells/mm3 on day 8
  • Discontinue if with severe or life-threatening anaphylactic reactions (eg hypotension, wheezing, angioedema, swelling, cardiac arrest) or grade 4 infusion-related reactions

Cytotoxic Chemotherapy

Drug Dosage Remarks
Carboplatin 400 mg/m2 IV infusion over
15-60 minutes every 4 weeks
In combination regimen:
AUC 4-6 IV every 3 weeks		 Adverse Reactions
  • Hematologic effects (bone marrow suppression, thrombocytopenia, neutropenia, anemia); GI effects (nausea/vomiting); Other effects (neurologic toxicity, nephrotoxicity)
Special Instructions
  • Contraindicated in patients with history of allergic reactions to Cisplatin or other platinum-containing compound, patients with severe bone marrow depression, significant bleeding, pre-existing severe renal impairment
  • Monitor closely blood counts, neurological and renal function
Cisplatin 50-120 mg/m2 BSA as a single IV
infusion every 3-4 weeks over 6-8 hours
or
15-20 mg/m2/day slow IV infusion for
5 days every 3-4 weeks		 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea); CNS effects (peripheral neuropathy, dizziness); Hematologic effects (leukopenia, anemia, thrombocytopenia); Other effects (tinnitus and/or hearing loss, anaphylactic-like reaction, elevated glutamic oxaloacetic transaminase [GOT], glutamic pyruvic transaminase [GPT], ALP, malaise, flush, edema)
Special Instructions
  • Use with caution in patients with renal and hearing impairment, hepatic disorder and myelosuppression
  • Discontinue use if there are elevated blood urea nitrogen (BUN) and serum creatinine and decreased creatinine clearance (CrCl)
  • Avoid using in patients with pre-existing severe renal impairment
  • Monitor renal output and fluid balance
  • Maintain adequate hydration before and 24 hours after administration to minimize nephrotoxicity
Doxorubicin 60-75 mg/m2 BSA as a single IV dose at 3-week interval Adverse Reactions
  • GI effects (GI disturbances, nausea/vomiting); Other effects (myelosuppression, cardiotoxicity, alopecia, hypersensitivity reactions, tissue necrosis, severe cellulitis)
Special Instructions
  • Avoid using in patients with myelosuppression, pre-existing heart disease and previous treatment with complete cumulative doses of Doxorubicin or Daunorubicin
  • Limit total cumulative doses to 450 mg/m2 to avoid cardiotoxicity
  • Monitor hematologic tests such as liver and renal function, blood counts and blood uric levels before and during treatment
Epirubicin 60-90 mg/m2 IV infusion over
3-5 minutes at 21-day intervals 		Adverse Reactions
  • GI effects (GI disturbances); Other effects (myelosuppression, cardiotoxicity, alopecia, mucositis, hyperpyrexia)
Special Instructions
  • Avoid using in patients with marked myelosuppression, cardiac impairment, and those treated with maximal cumulative doses of other anthracyclines
  • A total cumulative dose of 0.9–1 g/m2 should not be exceeded to avoid cardiotoxicity
  • Monitor lab parameters and cardiac function
Etoposide 60-100 mg/m2 IV infusion 24 hourly for 5 consecutive days followed by a
recession interval of 3 weeks		 Adverse Reactions
  • Dermatologic effect (alopecia); Endocrine effect (ovarian failure); GI effects (nausea/vomiting, anorexia, diarrhea, mucositis); Hematologic effects (leukopenia, thrombocytopenia, anemia); Other effect (rarely anaphylaxis)
Special Instructions
  • Do not administer SC or IM
  • Discontinue treatment if platelet count is <50,000/mm3, or ANC <500 cells/mm3
  • Use with caution in patients with hepatic and renal impairment
Gemcitabine 1,250 mg/m2 IV infusion on days 1, 8
and 15 of each 28-day cycle then the 4-week cycle is repeated

In combination with Cisplatin:
1,000 mg/m2 via 30-minute IV infusion on days 1, 8 and 15 of
each 28-day cycle
Cisplatin 70 mg/m2 is given on day 2 		Adverse Reactions
  • CV effects (peripheral edema, edema); CNS effects (pain, fever, somnolence); Dermatologic effects (rash, alopecia, pruritus); GI effects (nausea/vomiting, constipation, diarrhea, stomatitis); Hematologic effects (anemia, leukopenia, neutropenia, thrombocytopenia, hemorrhage, myelosuppression); Hepatic effect (increased liver enzymes); Renal effects (proteinuria, hematuria, increased BUN); Respiratory effect (dyspnea); Other effect (infection)
Special Instructions
  • Should be administered over 30 minutes; fixed-dose rate is recommended at 10 mg/m2/min
  • Use with caution in patients with renal or hepatic impairment, history of CV disease, severe fluid retention, and patients taking Warfarin
  • Discontinue treatment if signs of microangiopathic hemolytic anemia and renal failure is present
  • CBC should be monitored before initiation of weekly dose
Methotrexate 15-20 mg/m2 IV 2x weekly
or
30-50 mg/m2 IV once weekly
or
15 mg/m2/day IV/IM for 5 days 		Adverse Reactions
  • GI effects (stomatitis, gingivitis, nausea/vomiting, diarrhea, loss of appetite, intestinal perforation); CNS effect (dizziness); Dermatologic effects (alopecia, rash, severe reactions eg Stevens-Johnson syndrome, toxic epidermal necrolysis); Hematologic effects (leukopenia, thrombocytopenia); Other effects (hyperuricemia, menstrual dysfunction, fever, chills)
Special Instructions
  • Use with caution in patients with pre-existing bone marrow suppression, renal or hepatic impairment, peptic ulcer disease and ulcerative colitis
Mitomycin Prophylaxis: 4-10 mg intravesically
24 hourly or every 2 days
Treatment: 10-40 mg intravesically 24 hourly 		Adverse Reactions
  • Other effects (hemolytic-uremic syndrome, microangiopathic hemolytic anemia, nephropathy, marrow depression, interstitial pneumonia)
Special Instructions
  • Use with caution in patients with infectious disease and bleeding tendency
Tegafur1 300-600 mg PO 8-12 hourly Adverse Reactions
  • GI effects (severe diarrhea, nausea/vomiting, epigastric pain, stomatitis, abdominal pain, gastric and duodenal ulcer, gastritis); Hepatic effects (jaundice, increased GOT, GPT); Renal effects (increased BUN and hematocreatinine); Dermatologic effects (pigmentation, hot flushes, blisters, erosion, nail abnormality, itching, alopecia, dermatitis)
Special Instructions
  • Should be taken in an empty stomach or 1 hour before or after meals
  • Avoid using in patients receiving Sorivudine
  • Frequently monitor hematologic, hepatic and renal function
Valrubicin 800 mg administered intravesically weekly
(retain for 2 hours) for 6 weeks		 Adverse Reactions
  • Renal effects (urinary frequency, dysuria, urinary urgency, bladder spasm, hematuria, bladder pain, urinary incontinence, cystitis, UTI, nocturia); GI effects (abdominal pain, nausea); Other effect (local burning symptoms)
Special Instructions
  • Evaluate the status of the bladder before the intravesical instillation
  • Contraindicated in patients with perforated bladder or compromised bladder mucosa, hypersensitivity to anthracyclines or polyoxyl castor oil, concurrent UTIs, patients with a small bladder capacity unable to tolerate a 75 mL instillation
  • Use with caution in patients with severe irritable bladder symptoms
Vinflunine 320 mg/m2 IV infusion for 20 minutes
every 3 weeks		 Adverse Reactions
  • Hematologic effects (neutropenia, anemia); GI effects (constipation, anorexia, nausea/vomiting, abdominal pain, stomatitis, diarrhea); Other effects (asthenia, fatigue)
Special Instructions
  • Avoid using in patients with recent (within 2 weeks) or current severe infection, baseline ANC <15,000/mm3 for the first administration, ANC <1,000/mm3 for subsequent administrations, platelets <100,000/mm3
  • Use with caution in patients with high risk of constipation, arrhythmia, history of myocardial infarction (MI) or angina pectoris, or underlying cardiac disease
  • Do adequate monitoring of complete blood counts to verify ANC, platelet and hemoglobin (Hb) values prior to each infusion

¹Combination with Uracil is available. Please see the latest MIMS for specific formulations.

Supportive Care Therapy

Drug Dosage Remarks
Bacillus Calmette-Guérin (BCG) 80 mg intravesically for up to 2 hours once weekly for 6 weeks (once every week)
or
120 mg intravesically weekly 2-3 weeks after performing TURBT during the first 6 weeks, followed by 3 consecutive weekly instillations at 3 months, at
6 months and thereafter every 6 months up to 36 months		 Adverse Reactions
  • Urologic effects (contracted bladder, frequency, urgency of micturition, dysuria, cystitis); Other effects (malaise, low-medium grade fever or flu-like symptoms, BCG infections, interstitial pneumonia, systemic delayed-type hypersensitivity, Reiter’s syndrome)
Special Instructions
  • Do not administer IV, IM or SC
  • Do not administer <14 days following transurethral resection
  • Tuberculin test should be performed before the first instillation
  • Delay treatment in patients with traumatic catheterization
  • Contraindicated in patients with impaired immune response, positive human immunodeficiency virus (HIV) serology and tuberculin reaction in conjunction with existing tuberculosis (TB), UTI

Targeted Cancer Therapy

Drug Dosage Remarks
Monoclonal Antibodies
Durvalumab <30 kg: 20 mg/kg IV in combination with chemotherapy every 4 weeks for 4 cycles before surgery followed by 20 mg/kg as monotherapy every 4 weeks for up to 8 cycles after surgery
≥30 kg: 1,500 mg IV in combination with chemotherapy every 3 weeks for up to 4 cycles prior to surgery followed by 1,500 mg monotherapy every 4 weeks for up to 8 cycles
after surgery
Continue until disease progression or
unacceptable toxicity 		Adverse Reactions
  • Respiratory effects (cough, upper respiratory tract infection, pneumonitis, dysphonia, pneumonia, flu); GI effects (abdominal pain, diarrhea); Dermatologic effects (rash, pruritus); Other effects (pyrexia, increased AST/ALT, hyperthyroidism, increased creatinine, dysuria, night sweats, peripheral edema, oral candidiasis, dental and soft tissue infections, myalgia)
Special Instructions
  • Use with caution in patients with severe hepatic impairment
  • Withhold treatment in the presence of severe (grade 3) immune-mediated adverse reactions and permanently discontinue treatment in life-threatening (grade 4) and recurrent (grade 3) immune-mediated reactions
  • Monitor for abnormal liver, thyroid and renal function before and periodically during treatment and for signs and symptoms of pneumonitis, colitis/diarrhea or intestinal perforation, adrenal insufficiency, type 1 DM, hypophysitis or hypopituitarism, rash or dermatitis, immune-mediated myocarditis
Enfortumab vedotin (Enfortumab vedotin-ejfv) 1.25 mg/kg IV infusion over 30 minutes on days 1, 8 and 15 of
a 28-day cycle
Max dose (≥100 kg):
125 mg/kg IV 		Adverse Reactions
  • GI effects (nausea, diarrhea); Dermatologic effects (rash, pruritus, dry skin, alopecia); Other effects (fatigue, peripheral neuropathy, decreased appetite, dysgeusia, dry eye)
Special Instructions
  • Use with caution in patients with DM or risk for hyperglycemia
  • Monitor blood sugar level, infusion site, for new or worsening peripheral neuropathy, ocular disorders
Nivolumab 240 mg IV infusion over 30 minutes every 2 weeks
or
480 mg IV infusion over 30 minutes every 4 weeks		 Adverse Reactions
  • GI effects (abdominal pain, constipation, nausea); Respiratory effects (cough, dyspnea); Other effects (hyponatremia, increased AST/lipase, rash, fatigue, musculoskeletal pain)
Special Instructions
  • Monitor liver enzymes, serum creatinine and thyroid function
Pembrolizumab 200 mg IV infusion over 30 minutes every 3 weeks
or
400 mg IV infusion over 30 minutes every 6 weeks until disease progression or unacceptable
toxicity 		Adverse Reactions
  • GI effects (nausea, constipation, decreased appetite, diarrhea); Respiratory effects (cough, pneumonitis, dyspnea, pneumonia); Dermatologic effects (pruritus, rash, cellulitis); Other effects (fatigue, arthralgia, renal failure, pain)
Special Instructions
  • Withhold treatment if any of the following occurs: Moderate pneumonitis, moderate or severe immune-mediated colitis, moderate hypophysitis, severe hyperglycemia, moderate immune-mediated nephritis
  • Discontinue if life-threatening adverse events of pneumonitis, colitis, hypophysitis, hyperthyroidism, nephritis, infusion reactions, severe liver enzyme elevations occur
  • Monitor liver enzymes, serum creatinine, thyroid and renal function
Protein Kinase Inhibitor
Erdafitinib 8 mg PO 24 hourly until disease progression or unacceptable toxicity
May increase to 9 mg PO 24 hourly after 14-21 days of treatment (if serum phosphate is <5.5 mg/dL,
no ocular disorders or ≥grade 2 toxicity) 		Adverse Reactions
  • GI effects (dysgeusia, stomatitis, diarrhea, dry mouth, constipation, abdominal pain, nausea); Dermatologic effects (onycholysis, dry skin, alopecia, palmar-plantar erythrodysesthesia syndrome); Metabolic effects (increased phosphate, creatinine, AST, calcium, ALT, ALP, decreased sodium, albumin, magnesium, phosphate, decreased appetite); Other effects (fatigue, decreased Hb, dry eye, musculoskeletal pain)
Special Instructions
  • Perform monthly ophthalmological exams during the first 4 months of treatment, every 3 months afterwards, and at any time for visual symptoms
  • Monitor serum phosphate level at baseline, at 14-21 days after initiation of treatment and monthly or as clinically necessary
Others
Nadofaragene firadenovec-vncg 75 mL (conc 3 x 1011 viral particles) instilled into the bladder via a urinary
catheter once every 3 months up to 12 months or until disease progression or unacceptable toxicity 		Adverse Reactions
  • Urologic effects (bladder spasm, micturition, increased creatinine, hematuria, dysuria); Metabolic effects (hyperglycemia, hypertriglyceridemia, decreased phosphate); Other effects (instillation site discharge, chills, fever)
Special Instructions
  • Premedicate with an anticholinergic before instillation
  • Should be left in the bladder for 1 hour after instillation
  • Contraindicated in patients who are immunocompromised or immunodeficient and have allergy with interferon alfa
Nogapendekin alfa
inbakicept-plmn 		Induction dose:
400 mcg administered intravesically
with BCG once weekly for 6 weeks
A second induction course may be administered if complete response is not achieved at month 3
Maintenance dose:
400 mcg administered intravesically with BCG once weekly for 3 weeks at months 4, 7, 13 and 19
Patients with an ongoing
complete response at month 25
and later may receive additional
maintenance instillations with
BCG once weekly for 3 weeks at
months 25, 31 and 37 		Adverse Reactions
  • Urologic effects (increased creatinine, hematuria, dysuria, urinary frequency, micturition urgency, UTI); Other effects (increased potassium, musculoskeletal pain, chills, pyrexia)
Special Instructions
  • Total time from vial puncture to the completion of the intravesical instillation should not exceed 2 hours
  • Maintain adequate hydration following treatment
  • Perform purified protein derivative (PPD) test prior to treatment and verify pregnancy status before treatment initiation

Disclaimer

All dosage recommendations are for non-pregnant and non-breastfeeding women, and non-elderly adults with normal renal and hepatic function unless otherwise stated.  
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.  

Related MIMS Drugs