New treatment options of transitional cell carcinoma of the urinary bladder in the era of immunotherapy

05/2021

MUDr. Tomáš Blažek^1,2; doc. MUDr. Renata Soumarová, Ph.D., MBA³

¹ Onkologická klinika LF OU a FN, Ostrava

² 3. LF UK, Praha

³ Radioterapeutická a onkologická klinika FN Královské Vinohrady, Praha

SUMMARY

The treatment of transitional cell carcinoma of the urinary bladder has been changed and evolved over the last decade. New findings in the field of immuno-oncology research largely contribute to treatment improvements. Conventional treatment modalities, i.e. surgical treatment, radiotherapy and systemic chemotherapy are expanded in the light of emerging immunotherapy options. Historically, one of the first immunotherapeutic agents was the attenuated Bacillus Calmette-Guérin (BCG) vaccine. It was used for the treatment of superficial, non-invasive transitional cell carcinomas of the bladder. Since that, the study of immune mechanisms and interactions in the tumor microenvironment, supported with the efficacy of the BCG vaccine, contributed to the development of further improvements in immunotherapy. In the modern era of immunotherapy, new active molecules, i.e. checkpoint inhibitors, are used. The use of these active molecules, targeting surface receptors located on the tumor cells and immune system of the patient, offer new perspectives in the systemic treatment of metastatic or locally advanced transitional cell carcinoma of the urinary bladder. Specific aspects of immunotherapy, particularly the effectiveness, tolerance and toxicity profile, which have an important impact on the quality of life of patients, make immunotherapy a new, alternative modality in addition to conventional systemic chemotherapy. The purpose of this article is to provide an overview of the current possibilities of systemic therapy for bladder cancer using immunotherapy and checkpoint inhibitors.

Key words

bladder cancer, locally advanced/relapsed, metastatic bladder cancer, PD-1/PD-L1, immunotherapy, checkpoint inhibitors, pembrolizumab, nivolumab, atezolizumab, aveluma