Role of Perioperative Immune Checkpoint Inhibitors in Muscle Invasive Bladder Cancer

Abstract

Objective: We aim to describe and highlight the current use of immune checkpoint inhibitors (ICIs) in the muscle invasive bladder cancer (MIBC) treatment landscape, particularly focusing on the perioperative setting. We provide a comprehensive review of key trials of the use of ICI in the perioperative setting, discussing trial outcomes and limitations and reviewing the role of biomarkers. Introduction: ICIs have recently been integrated into the treatment algorithm for metastatic urothelial carcinoma. More than 30 published studies have investigated the role of these agents in the radical treatment of MIBC. Some studies have demonstrated conflicting results, affecting widespread adoption in clinical practice. Methods: We performed a narrative overview of the literature from databases including PubMed, MEDLINE, Embase, European society of Medical Oncology/American Society of Clinical Oncology Annual Proceedings, and clinicaltrials.gov databases up until December 2021. Discussion: We described the results of key trials in the neoadjuvant and adjuvant setting, some of the reasons for conflicting study results, and the implications for clinical practice. Relevant biomarkers in the field are discussed, alongside a brief overview of the immune microenvironment in bladder cancer. Conclusions: Perioperative ICIs have shown promising efficacy with low toxicity in the neoadjuvant setting. The two large trials in the adjuvant setting have been contradictory. The efficacy of perioperative ICIs combined with favorable tolerability and better toxicity profile compared with chemotherapy, with the

Case Report: A Presentation of Early-Onset Immune-Mediated Bullous Pemphigoid in a Patient with Urothelial Cancer

“…For muscle-invasive bladder cancer (MIBC), the results regarding tolerability and toxicity have been even better than chemotherapy and have proved to be a potential modern therapeutic intervention for refractory non-MIBC. Due to these reasons, ICIs are more frequently incorporated into the treatment regimens for metastatic urothelial cancers [ 15 , 16 ].…”

“…The lack of comprehensive long-term survival data for patients exposed to ICIs underscores the need for additional research to substantiate the apparent survival benefits. This transition to a more personalized treatment approach would be facilitated through the integration of new biomarkers and molecular changes, thereby reshaping the existing standard of care [ 15 , 16 , 20 ].…”