Bladder Cancer Drugs and Modern Treatment in the United States

Over the past several years, bladder cancer has become an increasingly serious health concern in the United States, especially among older adults and those with a history of long-term medication use. Beyond traditional risk factors such as smoking and chemical exposure, recent studies have warned that some commonly used prescription medications may inadvertently increase the risk of developing the disease. At the same time, advances in modern medicine have brought new hope, with breakthrough therapies such as Keytruda, Opdivo, and Lenvima being widely used to treat advanced bladder cancer.

1. Medications that can increase the risk of bladder cancer

Here are some drugs or drug classes noted in epidemiological studies and FDA warnings:

a. Pioglitazone (Actos) – a drug for type 2 diabetes

  • The FDA has warned since 2011 that long-term use (more than 1 year) may increase the risk of bladder cancer.

  • The risk is higher in people taking high doses, or who have pre-existing bladder disease.

b. Cyclophosphamide chemotherapy

  • Very strong, often used in the treatment of leukemia, lymphoma…

  • Causes hemorrhagic cystitis and can lead to secondary bladder cancer after many years.

c. Phenacetin (old pain reliever, now banned)

  • Commonly used before the 1980s, but was withdrawn from the market due to links to urinary tract cancers, especially bladder cancers.

d. Immunosuppressants (such as ifosfamide, cyclosporine)

  • Used in cancer treatment or after organ transplantation.

  • Weakens the immune system and creates conditions for cancer cells to grow.

2. Mechanism of drug-induced carcinogenesis

Some medications can cause DNA mutations in the cells that line the bladder. When these cells are damaged and not repaired properly, they can develop into malignant tumors. In addition:

  • Drugs excreted in the urine will concentrate in the bladder , increasing the contact time between the bladder mucosa and the mutagens.

  • Some intermediate metabolites of drugs in the liver can be more toxic than the original drug , and these substances contribute to cancer.

3. Modern treatment methods in the US: Keytruda, Opdivo, Lenvima

Keytruda (Pembrolizumab)

  • It is an immunotherapy drug that inhibits PD-1 , helping the immune system recognize and destroy cancer cells.

  • FDA approved to treat:

    • Advanced bladder cancer

    • When the patient cannot receive chemotherapy with cisplatin

    • When cancer recurs after chemotherapy

Opdivo (Nivolumab)

  • Similar to Keytruda, Opdivo is a monoclonal antibody that inhibits PD-1 .

  • Effective in treating advanced urological cancers, especially when the cancer no longer responds to conventional chemotherapy.

  • May be used after cystectomy to prevent recurrence.

Lenvima (Lenvatinib)

  • It is a tyrosine kinase inhibitor that blocks the pathways that feed the tumor.

  • Often used in combination with other therapies, although not as commonly as Keytruda/Opdivo, in the treatment of bladder cancer.

  • Investigated for cases that do not respond to immunotherapy alone.

4. Bladder cancer treatment trends in the United States

  • Immunotherapy is gradually replacing traditional chemotherapy , especially in the elderly or those with underlying medical conditions that cannot use cisplatin.

  • Hospitals in the US often order molecular biological testing to determine whether Keytruda/Opdivo is appropriate.

  • Many cancer centers are also testing combination therapies , such as Lenvima + Keytruda, to increase effectiveness.

5. Advice for patients and long-term medication users

  • Do not stop taking any medications without consulting your doctor if you are taking any of the risk medications (such as Pioglitazone). Consult your doctor.

  • Regular check-ups and urinary tract function tests if long-term medication is used.

  • People with a family history of bladder cancer should consider safer alternatives.

Conclude

Although certain prescription medications may contribute to the risk of developing bladder cancer, early detection and timely treatment with modern methods such as Keytruda, Opdivo, and Lenvima have significantly extended survival for patients in the United States.

If you or a loved one has a history of using the above medications or is undergoing cancer treatment, always talk to your doctor to get advice on the most appropriate method.