How Metastatic Bladder Cancer Treatments May Affect Your Vision, Skin, and Nerves — and Ways to Protect Them

“Early recognition and reporting of skin, neurologic, and ocular toxicities are critical,” says Fernando Maciel Barbosa, MD, a medical oncologist with Iowa Health Care in Iowa City. “Most adverse effects can be managed successfully without discontinuing therapy when identified promptly, allowing patients to remain on highly effective treatments while maintaining quality of life.”

Management usually involves a combination of at-home care, prescription medications, and importantly, communication with your oncology team.

The Skin: Spotting and Rashes

• Redness or rash
• Itching
• Dry, flaky, or peeling skin
• Increased sensitivity to sunlight
• Hand-foot syndrome, which is tingling, numbness, painful sensitivity, swelling, or soreness in hands and feet
• Hair loss or changes in texture
• Changes in hair color or skin color
• Swelling, redness, and sores around your fingernails and toenails, resembling an ingrown nail or infection

Some of these skin side effects are more common with certain medications than with others. “Most skin reactions are mild to moderate and manageable without stopping treatment, and topical steroids or antihistamines are often enough,” says Rohit Gosain, MD, medical director of hematology and oncology for the Roswell Park Care Network in Buffalo, New York. “Some research suggests that skin reactions may actually correlate with a better treatment response, but that doesn’t mean to ignore symptoms.”

It’s important to be aware that severe side effects can occur, particularly with the ADC enfortumab vedotin (Padcev). “About 50 to 60 percent of patients using enfortumab develop skin reactions,” says Douglas Dow, MD, a urological surgeon with Memorial Hermann Medical Group in Houston. “It has caused a severe, possibly fatal skin condition known as toxic epidermal necrolysis, also known as Stevens-Johnson syndrome, in about 5 percent of patients.”

If you’re being treated with enfortumab vedotin, it’s important to notify your doctor right away if you experience any of the early signs. Stevens-Johnson syndrome is considered a medical emergency and requires immediate care.

Preventive Care and Protective Care

• Apply fragrance-free moisturizer at least twice daily.
• Use mild soaps and avoid hot showers.
• Wear sunscreen (SPF 30 or higher) and protective clothing when outdoors.
• Stay well hydrated.
• Avoid scratching to reduce the risk of infection.
• Wash your hair with a gentle, moisturizing shampoo and protect your hair from heat (limit your use of blow dryers and curling irons).

For skin redness that can be caused by chemotherapy, Dr. Dow says that one or two high doses of vitamin D (100,000 international units) may help.

The Nerves: Peripheral Neuropathy

Some cancer treatments can damage the nerves outside of your central nervous system. This is known as peripheral neuropathy.

“Neuropathic symptoms are most commonly caused by cisplatin, which is a platinum-based chemotherapy, and enfortumab,” says Dow. “About 50 percent of patients have clinically significant peripheral neuropathy.”

In addition to the hands and feet, peripheral nerves in other parts of the body can be affected. “It can also manifest as loss of vibration sensation, loss of balance and physical coordination, and bowel or bladder disturbances,” says Dow.

Preventive Care and Protective Care

With enfortumab vedotin, nerve symptoms typically emerge around 11 to 12 weeks into treatment, says Dr. Gosain. “Most cases are mild to moderate, though a smaller percentage are more severe, and neuropathy is actually the leading reason this medication gets dose adjusted or discontinued,” he says.

While your care team may recommend a change to your medication dose or schedule, Gosain says you can help lessen nerve symptoms by:

• Avoiding alcohol
• Keeping blood sugar well controlled
• Staying physically active

Some patients try cold therapy (cooling the hands and feet using ice or ice packs), which has evidence behind it for other drugs but not specifically for enfortumab vedotin. “Medications like gabapentin or pregabalin are also options your doctor may discuss,” Gosain says.

Other steps you can take to protect yourself include:

• Fall Prevention In your home, move area rugs out of your path, put bath mats in the shower or tub, keep debris out of walkways, and rise slowly after sitting for a while or lying down.
• Protect Hands Use pot holders in the kitchen and take extra care with knives. If possible, have someone check the water in your shower to make sure it's not too hot.
• Care for Hands and Feet Wear shoes when indoors and outside, and check your arms, legs, feet, and hands daily for cuts and scratches. In cold weather, make sure that your hands and feet are protected.

“Patients should loop in their doctor as soon as symptoms appear, rather than waiting,” says Gosain. “I always tell patients that early reporting is what allows for dose or schedule adjustments before symptoms progress.”

The Eyes: Discomfort and Vision Changes

“Dry eyes are the most common among patients,” says Gosain. “Erdafitinib carries the highest eye-related risk among these therapies, though most cases remain mild.”

Preventive and Protective Care

“To protect vision and stay comfortable, consider preservative-free artificial tears for dryness, sunglasses outdoors, and reduced screen strain with regular breaks,” says Gosain.

You may have to avoid wearing contact lenses during treatment with erdafitinib or enfortumab vedotin, and you’ll need regular eye exams.

“For patients on erdafitinib specifically, monthly eye exams are required for the first four months, then every three months after that,” says Gosain.

“Patients should contact their healthcare team promptly if they develop sudden vision changes, persistent blurred vision, significant eye pain, severe redness, or any decrease in vision,” says Barbosa. “These symptoms require timely evaluation to prevent complications.”