Bladder cancer spreading and looking for options next steps.

Posted by scbil @scbil, Jan 7 1:56pm

My wife was diagnosed with bladder cancer in early 2025. Due to heart issues and age, surgical procedures were not viable. She completed a full series of radiation/chemo followed by BCG treatments and we seemed to be making good progress. A scan noted a lung nodule, we had the lung biopsy this past Monday and reported results are metastatic high grade urothelial carcinoma. Any ideas, recommendations, suggestions or what we should expect from those who have been through this?

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jaxfl | @jaxfl | 2 days ago

Very difficult scenario. EVP is extremely taxing as is chemo + ICI and other targeted therapies generally available are also highly toxic.

Speed up a discussion with the oncologist to ASAP.

You are in my prayers.

Holly | @eustacia55 | 1 day ago

Hi @scbil. I'm guessing your oncologist will lay out three scenarios for you. You know your wife's strengths and weaknesses - what she can handle like a champ and what will drain her. Then you will have to be honest with each other about managing the side effects.

1.) EVP will have skin rash side effects and the possibility of neuropathy.
2.) Another route might be Trodelvy but that can lower your wife's WBC counts making her susceptible to infections. It might also cause diarrhea and can lead to dehydration.
3.) Since she knows the team in radiation, your oncologist might suggest pinpointing the nodule and then trying a different type of chemo (to the one she originally used and will still be kind to her heart) alongside of Opdivo or Bavencio. (side effects of Opdivo are a little fatigue and leg aches - sometimes severe enough to stay in bed).

It will be a challenge navigating the side effects. So create a system to document the side effects as they crop up. The more vocal you are with the care team, the more preventative measures and work-arounds your team can try. One of the sweetest gestures you can make is just rubbing lotion into your wife's hands and feet. It will help her feel a little more human and reconnected with you - which is what makes you a stronger team.

Our best to you and your wife whichever route you try.

scbil | @scbil | 1 day ago

Thanks for the feedback. Met with her team today and they are prescribing Padcev and Keytruda on a three week cycle. Thoracic surgeon and oncologist have nixed any surgical procedure on the lungs which we are in agreement with based on age and heart issues. We will be watching for the side effects and, yes, have the lotion on hand. We have a great medical team and an even greater and larger prayer team.