Immunotherapy for upper urinary tract urothelial cancer (UTUC)

Immunotherapy uses the immune system to find and attack cancer cells. It is sometimes given after surgery. It can be a main treatment for UTUC that has spread to other parts of the body.

What is immunotherapy?

Immunotherapy drugs encourage the body’s immune system to find and attack cancer cells.

The following immunotherapy drugs are used to treat upper urinary tract urothelial cancer (UTUC):

  • BCG
  • checkpoint inhibitors.

You may have immunotherapy:

  • after surgery to reduce the risk of cancer coming back
  • if the cancer has spread to other parts of the body.


BCG is an immunotherapy drug that you may have after tumour ablation or some types of surgery.

You may have one dose of BCG into the bladder to help prevent the cancer coming back. This is called intravesical BCG. If you have a low risk of the cancer coming back, you usually do not need BCG.

If BCG is suitable for you, your doctor or nurse will tell you about the treatment and any side effects.

Checkpoint inhibitors

Immunotherapy drugs called checkpoint inhibitors are sometimes used to treat UTUC that has spread (locally advanced or metastatic cancer). These drugs are not suitable for people with certain medical conditions. Your doctor can talk to you about this.

You may have checkpoint inhibitors if the cancer continues to grow. Or you may have them if the cancer comes back after chemotherapy containing a platinum-based drug, such as cisplatin.

They may also be used if cisplatin is not suitable. Your cancer doctor or specialist nurse can give you more information about these drugs. The most commonly used checkpoint inhibitors are:

Sometimes a checkpoint inhibitor called avelumab (Bavencio®) may be used after chemotherapy.

Checkpoint inhibitors are given as a drip into a vein (intravenously).

Treatments may not be widely available on the NHS. If a drug is not available, there may be ways you can still have it. Your doctor can give you advice. They may be able to apply for funding to get it.

Immunotherapy side effects

Checkpoint inhibitors can make the immune system too active. This may cause inflammation in parts of the body. The most common parts to be affected are the:

  • skin – causing a rash
  • thyroid gland – causing it to become overactive or underactive
  • bowels – causing diarrhoea
  • joints – causing pain and swelling.

More rarely, these drugs cause problems in other places such as the:

  • liver
  • lung
  • heart
  • nerves
  • brain
  • other organs. 

This type of side effect may start weeks, months, or sometimes more than a year, after you finish treatment. 

Some people have very few side effects. But the side effects of checkpoint inhibitors can be serious. If you have any symptoms or side effects that start during treatment or after treatment finishes, contact your doctor or hospital straight away. 

We have information about individual checkpoint inhibitor drugs and their side effects.

About our information

  • References
    Below is a sample of the sources used in our upper urinary tract urothelial cancer (UTUC) information. If you would like more information about the sources we use, please contact us at
    European Association of Urology. Upper urinary tract urothelial carcinoma guidelines. EAU Guidelines. Edn. presented at the EAU Annual Congress Copenhagen 2018. ISBN 978-94-92671-01-1. Available from (accessed April 2021).
    National Institute for Health and Care Excellence (NICE). Atezolizumab for untreated PD-L1-positive locally advanced or metastatic urothelial cancer when cisplatin is unsuitable. Technology appraisal guidance (TA492). Published 06 December 2017. Last updated 12 July 2018. Available from  (accessed April 2021)
    Birtle A, et al. Adjuvant chemotherapy in upper tract urothelial carcinoma (the POUT trial): a phase 3, open-label, randomised controlled trial. The Lancet, 2020; 395, 10232, 1268-1277. Available from (accessed June 2021).


  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Lisa Pickering, Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

Date reviewed

Reviewed: 01 November 2021
Next review: 01 November 2024
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

Our cancer information meets the PIF TICK quality mark.

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