Immune Checkpoint Inhibitors in Front-line Therapy for Urothelial Cancer

Immune checkpoint inhibitors are the standard-of-care front-line treatment option for PD-L1-positive, cisplatin-ineligible metastatic urothelial carcinoma. The data supporting this are based on two single-arm trials. Randomised trials to confirm these findings and test new combinations have recently been performed. It was hoped that these trials would clarify some of the previous uncertainties. In this report we summarise the findings from these trials and perform a combined analysis. The results show that immune checkpoint inhibitor monotherapy is not superior to chemotherapy as things currently stand. The chemoimmunotherapy combination shows a probable efficacy signal, but this appears to be insufficient to change practice. PATIENT SUMMARY: In this report, we summarise the outcomes of three recent trials that investigated immunotherapy (IMT) on its own and combined with chemotherapy (CT) for patients with metastatic bladder cancer who had not previously received any treatment. We show that IMT on its own is not better than CT for these patients. There is a sign that combined CT and IMT probably has a benefit, but it does not seem to be large enough to justify a change in treatment recommendations.