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Immune Checkpoints Inhibitors in the Management of High-Risk Non-Muscle-Invasive Bladder Cancer. A Scoping Review - Beyond the Abstract

Bladder urothelial carcinoma is one of the first neoplasms recognized as immunogenic; From this knowledge, the recommended management for non-muscle invasive bladder cancer (NMIBC) after endoscopic resection is the use of bacillus Calmette-Guérin (BCG). However, about half of patients do not respond to initial management or fail to maintain their response long-term. These oncological results have motivated the progress in the investigation of the immunological biology of urothelial cancer and have grown with notable advances in the last 10 years.


Our scoping review focused on immune checkpoint inhibitors as a therapeutic option for NMIBC provides guidance on the current treatment for those patients who do not accept or are not candidates for radical cystectomy. The results of therapeutic development with immunotherapy are led by Pembrolizumab, a PD-1 inhibitor, supported by the results of KEYNOTE-05, which showed its antitumor impact and tolerance, achieving its approval by the FDA in 2020. Based on this result, the efforts of the Immunotherapy research are pressing, and future results are expected with atezolizumab, whose antitumor activity has been demonstrated in the treatment of metastatic bladder cancer. SWOG S1605 closed in March 2022, a single-arm phase II clinical trial tested systemic atezolizumab, achieving preliminary results with complete response at 6 months in CIS patients in 41.1% and a median duration of response of 16.5 months, results that promise conclusions favorable. There are several ongoing clinical trials based on the immunogenic principle, including oncolytic adenoviruses, recombinant proteins, and other checkpoint inhibitors in patients without prior BCG therapy.

In this way, the window of possibilities is opened for alternative treatments as effective as radical surgery. Professionals involved in the care of these patients could offer new therapeutic options that help mitigate the rapid evolution of this disease, its high rate of recurrence, and its progression.

Written by: Angie López Sánchez MD,1 Philippe E. Spiess MD MS FRCS(C), FACS2,3,4 Herney Andrés García-Perdomo MD MSc EdD PhD FACS5,6

  1. Department of Surgery / Urology. Medicine School. Universidad de Cartagena. Cartagena, Colombia.
  2. Department of Genito-Urinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
  3. Department of GU Oncology and Tumor Biology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
  4. Urology and Oncology, University of South Florida, Tampa, FL, USA
  5. Section of Urology/Urooncology. Department of Surgery. Medicine School. Universidad del Valle. Cali, Colombia.
  6. UROGIV Research Group. Universidad del Valle. Cali, Colombia

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