Role of Perioperative Immune Checkpoint Inhibitors in Muscle Invasive Bladder Cancer.

We aim to describe and highlight the current use of immune checkpoint inhibitors (ICIs) in the muscle invasive bladder cancer (MIBC) treatment landscape, particularly focusing on the perioperative setting. We provide a comprehensive review of key trials of the use of ICI in the perioperative setting, discussing trial outcomes and limitations and reviewing the role of biomarkers.

ICIs have recently been integrated into the treatment algorithm for metastatic urothelial carcinoma. More than 30 published studies have investigated the role of these agents in the radical treatment of MIBC. Some studies have demonstrated conflicting results, affecting widespread adoption in clinical practice.

We performed a narrative overview of the literature from databases including PubMed, MEDLINE, Embase, European society of Medical Oncology/American Society of Clinical Oncology Annual Proceedings, and databases up until December 2021.

We described the results of key trials in the neoadjuvant and adjuvant setting, some of the reasons for conflicting study results, and the implications for clinical practice. Relevant biomarkers in the field are discussed, alongside a brief overview of the immune microenvironment in bladder cancer.

Perioperative ICIs have shown promising efficacy with low toxicity in the neoadjuvant setting. The two large trials in the adjuvant setting have been contradictory. The efficacy of perioperative ICIs combined with favorable tolerability and better toxicity profile compared with chemotherapy, with the potential for biomarker-driven patient selection, may lead to a change in future practice. There is, however, a lack of long-term survival and toxicity data for those treated with ICIs, and this needs to be developed further to demonstrate an added survival benefit by using ICIs.

Oncology and therapy. 2023 Jan 03 [Epub ahead of print]

Saachi Chhaya, Isabella Watts, Kenrick Ng, Rami Mustapha, Thomas Powles, Anand Sharma, Nikhil Vasdev

Department of Clinical Oncology, Royal Marsden Hospital, London, UK. ., Department of Medical Oncology, Royal Free Hospital, London, UK., School of Cancer and Pharmaceutical Sciences, King's College London, London, UK., Barts Experimental Cancer Medicine Centre, Barts Cancer Institute, Queen Mary University of London, London, UK., Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK., Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, UK.