Systemic therapy issues: Immunotherapy in nonmetastatic urothelial cancer

摘要: Abstract Non–muscle-invasive bladder cancer is one of the most common malignancies. Patients with intermediate-risk or high-risk disease can be treated intravesical Bacillus Calmette-Guerin, a vaccine against tuberculosis. However, many these patients will experience tumor recurrence, despite appropriate treatment. 1 The standard care in radical cystectomy (RC) urinary diversion. 2 diagnosed muscle-invasive (MIBC) have traditionally faced main treatment options: RC and diversion, as Calmette-Guerin-unresponsive cancer, alternatively, trimodal therapy comprising maximal transurethral resection plus chemoradiation. 3 For MIBC clinical (c)T2–T4a, neoadjuvant chemotherapy (NAC) preceding supported by Level evidence modest 5-year overall survival benefit 5% cisplatin-based regimens. 4–9 A number factors preclude from options. example, serious comorbidities might unable to tolerate general anesthesia, while others unwilling adapt lifestyle changes after RC. 10-12 Likewise, extensive carcinoma situ poor function not optimal candidates for prepared ongoing risk that salvage ultimately required. Reasons underuse NAC range fear delaying potentially curative surgery nonresponders patient ineligibility NAC. 13,14 Despite best efforts, both surgical bladder-sparing approaches, only 35% 50%. 3,15 Strategies improve prognosis well reduce indications are desperately needed. Trial results demonstrated unprecedented ability immune-checkpoint inhibitors induce durable remissions some metastatic urothelial carcinoma. 16-20 Furthermore, shown better tolerated than traditional chemotherapy. 16 These successful spearheaded research on agents earlier settings, shared goal improving outcomes, avoid who show complete response (pT0). enhance immune combining immunotherapy sensitizers such chemotherapy, immunotherapy, targeted radiation rise.