The landscape of immunotherapy in treating bladder urothelial cancers is rapidly evolving. Initially approved for second-line therapy in patients who did not respond to platinum-based chemotherapy, checkpoint inhibitors have now found broader applications. Notably, maintenance therapy with avelumab following a complete response, partial response, or stable disease after platinum-based chemotherapy has been shown to improve overall survival, establishing it as a standard of care.
For first-line treatment of metastatic urothelial cancer, immunotherapy is deemed appropriate for patients with high PD-L1 expression or those who are ineligible for platinum-based treatments. Additionally, pembrolizumab presents a viable option for high-risk BCG-refractory patients who either cannot undergo or refuse cystectomy.
Ongoing clinical trials are exploring the use of immunotherapy in neoadjuvant and adjuvant settings for perioperative muscle-invasive bladder cancer, indicating a promising future for these treatments. The pivotal trials that have led to FDA approvals for these therapies, along with ongoing research, underscore the dynamic and expanding role of immunotherapy in bladder cancer management.
