Perioperative immunotherapy in muscle-invasive bladder cancer

Muscle-invasive bladder cancer (MIBC) and non-muscle-invasive bladder cancer (NMIBC) are both major causes of morbidity and mortality. At diagnosis, MIBC is more likely to metastasize, but can often be treated with aggressive care. Standard treatment for MIBC patients is radical cystectomy but a select group of these individuals are not candidates for or will decline this treatment. Thus, bladder preservation therapy followed by combined chemoradiation may be considered. Despite the primary surgical management of MIBC, up to half of patients will obtain tumors at distant sites in the end and perioperative platinum-based chemotherapy comprises the standard of care. However, despite these aggressive treatment options, survival is poor and therefore, it is essential to combine local and systemic therapies. Therapeutic modalities contained cancer vaccines, immune checkpoint inhibitors and immunogenic therapy are emerging as alternatives to immunotherapy, and several drugs have recently been approved by the FDA. Currently, several trials of adjuvant immunotherapy based on checkpoint inhibitors that as monotherapy, inhibit the reaction between programmed death-receptor 1 (PD-1) and programmed death-receptor ligand 1 (PD-L1). Or combined therapies mixed with chemotherapy, radiation, or various immunotherapy are ongoing. This review summarizes the current state of immunotherapies and evolution of the chemotherapy landscape for MIBC perioperative treatment. Widespread research is currently being performed to investigate the role of perioperative immune checkpoint inhibition in both the neoadjuvant and adjuvant setting.