Journal Article

Emerging Role of Immunotherapy in Advanced Urothelial Carcinoma

Grivas, Petros, Koshkin, Vadim S

2018

Overview

Purpose of ReviewAdvanced urothelial carcinoma (aUC) has long been treated preferably with cisplatin-based chemotherapy, but many patients are cisplatin-ineligible whereas for those who progress on a platinum-based regimen treatment options are limited. We review key recent data regarding immune checkpoint inhibitors that are changing this treatment landscape.Recent FindingsSince May 2016, five different agents targeting the PD-1/PD-L1 pathway (atezolizumab, pembrolizumab, nivolumab, avelumab, durvalumab) have received FDA approval for the treatment of aUC in the platinum-refractory setting, while pembrolizumab and atezolizumab are FDA-approved for cisplatin-ineligible patients in the first-line setting. Clinical outcomes and safety profiles of these agents appear relatively comparable across separate trials; however, only pembrolizumab is supported by level I evidence from a large randomized phase III trial showing overall survival benefit over conventional cytotoxic salvage chemotherapy in the platinum-refractory setting.SummaryPembrolizumab has the highest level of evidence in platinum-refractory aUC, whereas pembrolizumab and atezolizumab have comparable level of evidence in the frontline setting in cisplatin-ineligible patients. Ongoing research is evaluating novel agents, various rational combinations, and sequences, as well as predictive and prognostic biomarkers.

• Publisher: Springer Nature B.V
• Subject: Bladder cancer / Chemotherapy / Cisplatin / Clinical trials / Cytotoxicity / FDA approval / Immune checkpoint inhibitors / Immunotherapy / Monoclonal antibodies / Patients / PD-1 protein / PD-L1 protein / Platinum / Targeted cancer therapy / Urothelial carcinoma