Neoadjuvant immunochemotherapy in the treatment of nonmetastatic muscle-invasive bladder cancer: a systematic review.

Introduction: Multiple trials are currently studying the additional effect of immunotherapy on neoadjuvant chemotherapy (NAC) in nonmetastatic muscle-invasive bladder cancer. Methods: We performed a systematic review of the literature that summarizes all ongoing trials, with their results when available. Results: From an initial 269 trials identified, 17 were included. Pathological response and pathological complete response rates of the immunotherapy + NAC combination in the cisplatin-eligible population varied between 56.6-75% and 34.0-66.7%, respectively. Two studies published their results in the cisplatin-ineligible population, with pathological complete response rates of 18 and 45.2%. Conclusion: Neoadjuvant immunochemotherapy in platinum-eligible patients results in response rates higher than those reported for NAC alone. Strong preliminary results are still lacking in the platinum-ineligible population.

When possible, chemotherapy containing cisplatin is recommended before patients undergo radical surgery for bladder cancer. Multiple studies are currently evaluating the additional effect of immunotherapy (drugs that activate the immune system). We reviewed all ongoing studies and found an apparent better control of bladder cancer with the chemotherapy + immunotherapy combination. Stronger studies are needed, however, to confirm these preliminary results. In patients who cannot receive cisplatin, different chemotherapy + immunotherapy combinations were used, but with inconclusive results.

Immunotherapy. 2022 Nov 30 [Epub ahead of print]

Julien Sarkis, Enguerrand Vannier, Georges Mjaess, Corentin Pochet, Simone Albisinni, Thierry Quackels, Thierry Roumeguère

Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium., Department of Surgical Sciences, Urology Unit, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy.