Immunotherapy in non-metastatic urothelial cancer: back to the ‘future’

Abstract

Introduction: Successful results of immuno-oncological drugs in metastatic urothelial cancer have triggered interest of researchers to test it in non-metastatic setting. Conventional treatment modalities in that space are limited, sometimes toxic and with no improvement seen for the last 20 years and beyond. For patients failing intravesical BCG and mitomycin C in non-muscle invasive bladder cancer, no effective therapeutic alternatives exist besides cystectomy. In the neoadjuvant setting, cisplatin based chemotherapy provides limited benefit in terms of disease recurrence and metastases, at the expense of toxic effects. The good news is that preliminary studies are showing great promise with the use of immunotherapy in the local and loco-regional disease. Larger studies are now on the way to confirm the exciting potential benefits of immunotherapy in this direction. Areas covered: This review presents an overview on developments happening on the introduction of immunotherapy in non-metastatic urothelial cancer treatment. Expert opinion: Immunotherapy in the non-metastatic disease setting in urothelial cancer is evolving. Early results tend to anticipate a predominant role in coming times. Large comparative trials are in progress to gather robust practice changing evidence to bring a paradigm shift in the treatment landscape.

Urinary biomarkers in bladder cancer: A review of the current landscape and future directions

“…The development of prognostic or predictive markers may influence decision-making in the context of organ-preservation versus radical approaches of treatment. Further, they may help risk-stratify patients to receiving treatment intensification with adjuvant immunotherapy in the future [83].…”