Immunotherapy role in bladder cancer treatment: a review of literature

Abstract

Immunotherapy has changed the landscape of bladder cancer treatment in recent years, both for localized and metastatic bladder cancer. While bacillus Calmette–Guérin (BCG) remains the gold standard for high-risk non–muscle-invasive bladder cancer, the development of checkpoint inhibitors continues to increase treatment options for patients who are intolerant or unresponsive to BCG. In the setting of muscle-invasive bladder cancer, perioperative checkpoint blockade has shown promising pathologic response rates and survival signals, especially in PDL1/CPS enriched populations. In metastatic bladder cancer, anti–PD-1/PD-L1 therapy can lead to durable responses in a subset of patients, and combination strategies, sequences of therapy, and biomarkers are all being explored to help guide patient selection and improve clinical outcomes. Herein, we review evidence supporting the use of immunotherapy in non-muscle invasive, muscle invasive, and metastatic bladder cancer including the newer immunotherapy combination approaches.