Perioperative Immunotherapy in Muscle-Invasive Bladder Cancer and Upper Tract Urothelial Carcinoma

Abstract

Neoadjuvant chemotherapy improves survival in patients with muscle-invasive bladder cancer. However, a significant proportion of patients are ineligible for cisplatin owing to renal impairment or other medical comorbidities. The introduction of anti-programmed cell death protein 1/programmed death-ligand 1(PD1/PD-L1) checkpoint inhibitors has redefined the therapeutic landscape for platinum-resistant urothelial cancers; their clinical efficacy and favorable toxicity render these agents attractive therapeutic options either as monotherapy or in combination with other agents in earlier disease states, including muscle-invasive disease. We review potential perioperative immunotherapy strategies, ongoing clinical trials and areas of unmet needs, including upper tract disease and non-urothelial cancers.

Keywords: Muscle-invasive bladder cancer; PD-L1; PD1; Renal pelvis urothelial carcinoma; Transitional cell carcinoma; Ureteral carcinoma; Urothelial carcinoma.