PD-1 and PD-L1 inhibitors after platinum-based chemotherapy or in first-line therapy in cisplatin-ineligible patients: Dramatic improvement of prognosis and overall survival after decades of hopelessness in patients with metastatic urothelial cancer.

摘要: Until recently, there were no true innovations in the management of locally advanced (aUC) and metastatic urothelial cancer (mUC) last three decades. Vinflunine has been approved by EMA (European Medicines Agency) with only limited improvement compared to best supportive care second line treatment. In addition, gemcitabine/cisplatin established as an alternative methotrexate, vinblastine, doxorubicin, cisplatin (MVAC). The advent checkpoint inhibitors (CPI) revolutionized these patients, transforming a unanimously deadly disease into one hope through sustained control. Five immune CPI have recently for aUC/mUC US Food Drug Administration (FDA) including atezolizumab, nivolumab, pembrolizumab, durvalumab avelumab. All five are FDA-approved second-line therapy atezolizumab pembrolizumab also being first-line cisplatin-ineligible patients. rapid acceptance treatment algorithm UC is based on impressive clinical efficacy agents some combined their excellent safety profile. These new indeed most important advancement care. However, challenge age precision medicine identify patients who likely benefit from CPIs, majority do not respond CPI. Toward this goal, validation clinical, molecular imaging biomarkers that serve prediction monitoring response central necessity.