An update on immunotherapy options for urothelial cancer

Area of Science:

• Oncology
• Immunotherapy

Background:

• Urothelial cancers exhibit high mutational load and PD-L1 expression, making them susceptible to immune checkpoint inhibitors (ICIs).
• The clinical application of ICIs in urothelial cancer treatment is under extensive investigation across various lines of therapy.

Purpose of the Study:

• To review the evolution of immune checkpoint inhibition in urothelial cancers.
• To present current data on ICI use in first-line and second-line settings for cisplatin-ineligible patients.
• To summarize findings from ongoing and published clinical trials.

Main Methods:

• A literature search was conducted using PubMed, Medline, and ASCO/ESMO abstracts.
• Search terms included specific ICIs (nivolumab, pembrolizumab, atezolizumab, avelumab, durvalumab) and "urothelial cancer."

Main Results:

• Immune checkpoint inhibitors (ICIs) demonstrate effectiveness as monotherapy in advanced urothelial carcinoma for cisplatin-ineligible patients and those previously treated with chemotherapy.
• Efficacy data for first-line ICI monotherapy in advanced urothelial carcinoma is robust for specific patient populations.

Conclusions:

• ICIs are effective first-line treatments for advanced urothelial carcinoma patients ineligible for cisplatin and for those pre-treated with platinum-based chemotherapy.
• The role of combination ICI and chemotherapy in the first-line setting for advanced urothelial cancer requires further investigation to establish a potential new standard of care.