Onkológia 3/2025
Immunotherapy for muscle infiltrating urothelial carcinoma in 2025
This review is devoted to the current immunotherapy for urothelial carcinoma of the bladder and upper tract. The addition of durvalumab to cisplatin-based chemotherapy with subsequent immunotherapy following radical surgery improved outcomes in the neoadjuvant setting of muscle-infiltrating disease. When patients underwent surgery alone or did not achieve an objective response to neoadjuvant therapy, the current standard for PD-L1 positive carcinoma is nivolumab up to a year. First-line advanced disease should preferably be treated with a combination of pembrolizumab and enfortumab vedotin. If this combo is not available, a platinum derivative with gemcitabine and maintenance avelumab at objective response or stabilization to chemotherapy, alternatively cisplatin with gemcitabine and nivolumab are recommended. Following progression on chemotherapy, pembrolizumab is considered the standard of care. Efficacy and safety of immunotherapy in patients 65 years and older were demonstrated by the subgroup analyses of phase 3 studies.
Keywords: urothelial carcinoma, perioperative treatment, immunotherapy, efficacy, elderly patients
