An update on immunotherapy options for urothelial cancer

Abstract

Introduction: The efficacy of immune checkpoint inhibitors has been shown in many malignancies. Urothelial cancers have a high mutational load and also express a high level of PD-L1. Therefore, the use of immune checkpoint inhibitors (ICIs) in various treatment lines is being intensively investigated in urothelial cancers.Area covered: In this review article, we aimed to summarize the development of immune checkpoint inhibition in urothelial cancers. We also provide updated and comprehensive data about the use of ICIs in the second-line and first-line treatment of patients who are ineligible for cisplatin. We also summarize ongoing trials and the results of published trials. A literature search was made using PubMed, Medline, and ASCO and ESMO Annual Meetings abstracts by using the following search terms: nivolumab, pembrolizumab, atezolizumab, avelumab, durvalumab, and urothelial cancer.Expert opinion: ICIs as a monotherapy are effective for the first-line treatment of the patients with advanced urothelial carcinoma who are ineligible for cisplatin, and also patients who are pre-treated with platinum-based chemotherapy. The results of trials investigating the efficacy of the combination of ICIs and chemotherapy in the first-line setting are awaited; it remains unclear as to whether this combination may become the standard first-line treatment in advanced urothelial cancer.

Keywords: Immune checkpoint inhibition; PD-1; PD-L1; urothelial cancer.