Systemic therapy in muscle-invasive and metastatic bladder cancer: current trends and future promises.
Bladder urothelial cancers remain an important urologic cancer with limited treatment options in the locally advanced and metastatic setting. While neoadjuvant chemotherapy for locally advanced muscle-invasive cancers has shown overall survival benefit, clinical uptake in practice have lagged behind. Controversies surrounding adjuvant chemotherapy use are also ongoing. Systemic therapies for metastatic bladder cancer have largely used platinum-based therapies without effective standard second-line therapy options for those who fail, although vinflunine is approved in Europe as a second-line therapy based on a Phase III trial, and most recently, atezolizumab, a checkpoint inhibitor, was approved by the US FDA. Given increasing recognition of mutational signatures expressed in urothelial carcinomas, several promising agents with use of VEGF-targeted therapies, HER2-directed agents and immunotherapies with PD-1/PD-L1 antibodies in various settings are discussed herein.
Inova Schar Cancer Institute, Fairfax, VA, USA.
Jeanny B
JB
Aragon-Ching
Inova Schar Cancer Institute, Fairfax, VA, USA.
Donald L
DL
Trump
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy*; D006801:Humans; D008495:Medical Oncology / Q000639:trends*; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy*
D000970:Antineoplastic Agents
FGFR inhibitors; PD-1 inhibitors; PD-L1 inhibitors; atezolizumab; avelumab; immunotherapy; muscle-invasive bladder cancer; transitional cell cancer; urothelial cancer