Arjun V. Balar, MD
After a series of rapid approvals, checkpoint blockade immunotherapy has emerged as a key component of an increasingly complex treatment landscape in advanced and metastatic urothelial carcinoma (mUC). Researchers now are turning their attention toward earlier disease settings involving patients who are refractory to standard therapies in nonmuscle-invasive bladder cancer (NMIBC) or who are poor candidates for surgery in muscle-invasive bladder cancer (MIBC).
For cisplatin-ineligible patients, pembrolizumab is now indicated for those with a PD-L1 expression combined positive score (CPS) ≥10%. Atezolizumab is now approved for cisplatin-ineligible patients whose PD-L1 expression is ≥5% on tumor-infiltrating immune cells (ICs). Both drugs also are indicated for patients who are not eligible for any platinum-containing chemotherapy regardless of PD-L1 status.
Figure. Current Therapeutic Paradigm in Bladder Cancer1
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