[Immune checkpoint inhibition in metastatic urothelial carcinoma]

The treatment of metastatic urothelial carcinoma is characterized by the administration of combinatory regimes of chemotherapy. In the first-line treatment theses regimes demonstrate relatively good objective response rates and prolongation of overall survival. The prognosis declines if the patient is refractory to platin in the second- or third-line treatment or if the patient is ineligible for cisplatin in the first-line setting. Cisplatin ineligibility is defined by a poor renal function or subsequent comorbidities. The new class of immune checkpoint inhibitors (ICI) has led to an impressive improvement in the therapy of mUC in platin-refractory or cisplatin-ineligible patients. Currently, the EMA has approved Atezolizumab, Nivolumab and Pembrolizumab based on phase II and III trial data. Future developments focus on first-line and adjuvant treatment of ICI with PD-L1/PD-1 as a backbone and in combination with either other ICI or chemotherapy. The prognostic use of biomarkers in ICI is still a medical need as the currently available results with regard to the PD-L1 status are heterogeneous.