Updated on December 9, 2025.
Bladder cancer most often refers to a type of cancer called urothelial carcinoma. This type of cancer begins in the urothelial cells that make up the inner lining of the organs and structures in the urinary tract. Urothelial carcinoma can also begin in the kidneys and the ureters, tubes that connect the kidneys to the bladder.
Metastatic urothelial bladder cancer is a type of advanced cancer that began in the bladder but has spread beyond the bladder to other areas of the body. This can include lymph nodes, bones, and other organs, such as the lungs.
Treatment for metastatic urothelial bladder cancer typically involves one or several types of cancer drugs. Over the past decade, immunotherapy drugs called immune checkpoint inhibitors have become an important part of many treatment plans. These drugs are often used in combination with other types of cancer therapies, such as chemotherapy and antibody drug conjugates.
What are immune checkpoint inhibitors?
The body’s immune system is capable of destroying cancer cells. However, cancerous cells have ways of evading the immune system. One method involves proteins called immune checkpoints.
These proteins are found on healthy cells, and they help the immune system identify what is a healthy cell and what is something abnormal that needs to be eliminated. Many types of cancerous cells produce large amounts of immune checkpoints. When the immune system encounters these cells, it ignores them. In simple terms, immune checkpoints act as a disguise.
Immune checkpoint inhibitors are drugs that disable immune checkpoints. This enables the immune system to identify and destroy the cancerous cells.
To get more specific, the immune checkpoint inhibitors used in the treatment of metastatic urothelial bladder cancer are PD-1 and PD-L1 inhibitors. PD-1 and PD-L1 refer to specific immune checkpoints that cancer cells can use to avoid detection by the immune system:
- PD-1 (programmed cell death protein-1)
- PD-L1 (programmed death-ligand 1)
How are immune checkpoint inhibitors administered?
Immune checkpoint inhibitors are given as infusions. Some are given as intravenous infusions, or infusions into a vein. Others are given as subcutaneous infusions, or infusions into a layer of tissue underneath the skin.
How a therapy is given, where you need to go for an infusion, and what to expect during an infusion are all important topics to discuss with a healthcare provider.
What drugs are used with immune checkpoint inhibitors?
Mentioned above, immune checkpoint inhibitors can be used along with other cancer therapies, including chemotherapy and antibody drug conjugates.
- Chemotherapy drugs work by killing cancer cells or preventing cancer cells from dividing. This can shrink tumors and slow the growth of cancer.
- Antibody drug conjugates can be thought of as a combination of immunotherapy and chemotherapy. They are lab-produced immune proteins that contain a chemotherapy drug. These drugs can target cancer cells with greater precision while helping avoid damage to healthy cells.
Different drugs are used in different combinations. For example, a person may be prescribed an immune checkpoint inhibitor plus an antibody drug conjugate, or treatment with chemotherapy may be followed by treatment with an immune checkpoint inhibitor.
What should you ask your healthcare team?
Before starting immunotherapy or any other type of cancer treatment, it’s important to discuss how a treatment works, what you can expect to feel like during treatment, side effects, and other important topics. Here are some questions to ask at your appointment:
- How does this treatment work?
- Will it be given along with another kind of cancer therapy?
- How often will I receive treatment?
- How long does it take to administer?
- How long will I be on this therapy?
- Where will I receive treatment?
- What side effects are common?
- What is the risk of serious side effects, and how will side effects be monitored?
- Can this treatment interact with other medications I am taking? Your healthcare team should have an up-do-date list of all prescriptions, over the counter medicines, and supplements you take.
- How will immunotherapy affect my daily life? Will I be tired? What will I need help with?
- How will we know if the treatment is working?
- How much will this therapy cost?
- What are my options if this therapy doesn’t work?
Remember that metastatic urothelial bladder cancer is different for everyone. Your best source of information about diagnosis and treatment will be your healthcare team.
