Role of immunotherapy in perioperative treatment of localized muscle-invasive urothelial cancer

Background Immune checkpoint inhibitors are the standard of care in the first-line and second-line treatment of metastatic and locally advanced urothelial cancer. The use of immunotherapy in perioperative treatment is a new focus in the uro-oncological landscape. Current studies are investigating immune checkpoint inhibitors as monotherapy and in combination with chemotherapy or irradiation in the perioperative setting. Objective Overview of the currently published data, overview of new study concepts and an outlook on future developments in perioperative immunotherapy. Conclusion Neoadjuvant monotherapy with immune checkpoint inhibitors has failed to show sufficient response rates in muscle-invasive bladder cancer. In contrast, higher response rates have been observed for combinations of immunotherapy and established chemotherapy regimens, so that current phase III trials are now investigating this approach. Among others, sandwich regimens consisting of neoadjuvant immunochemotherapy and adjuvant immunotherapy following radical cystectomy are currently being investigated. Immune checkpoint inhibitors were investigated as adjuvant treatment in patients with high risk of recurrence in muscle-invasive urothelial cancer following radical resection. In this group a significant advantage with respect to disease-free survival (DFS) was observed for adjuvant immunotherapy with nivolumab. The effect was particularly pronounced in patients with a tumor status positive for programmed cell death 1 ligand 1 (PD-L1), so that the European Medicines Agency (EMA) has approved adjuvant immunotherapy with nivolumab for this subgroup as a new uro-oncological treatment indication.     «

Background Immune checkpoint inhibitors are the standard of care in the first-line and second-line treatment of metastatic and locally advanced urothelial cancer. The use of immunotherapy in perioperative treatment is a new focus in the uro-oncological landscape. Current studies are investigating immune checkpoint inhibitors as monotherapy and in combination with chemotherapy or irradiation in the perioperative setting. Objective Overview of the currently published data, overview of new study co...     »