Abstract
The treatment landscape for bladder cancer has undergone a rapid evolution in the past five years with the approval of seven new agents. New classes of medications have improved outcomes for many patients who previously had limited treatment options, but there is still much to learn about how to optimize patient selection for these agents and the role of combination therapies. The aims of this review are to discuss these newly approved agents for bladder cancer and to feature promising drugs and combinations—including immune checkpoint inhibitors, targeted therapies, and antibody–drug conjugates—that are in development.
Highlights
Bladder cancer is the sixth most common malignancy in the US, where over 80,000 new cases are diagnosed per year[1]
Grade 3 or 4 treatmentrelated adverse events were more common with NIVO1+IPI3 compared with nivolumab (39.1% versus 26.9%), these results suggest that combination therapy may provide a significant benefit over monotherapy, for patients whose tumors express PD-L1
In June 2018, interim analyses of these two trials showed that patients with low PD-L1 expression receiving atezolizumab or pembrolizumab monotherapy had decreased survival compared with patients with low PD-L1 expression who received platinum-based chemotherapy, leading to a change in drug approval[16]
Summary
Bladder cancer is the sixth most common malignancy in the US, where over 80,000 new cases are diagnosed per year[1]. Non-muscle-invasive bladder cancer (NMIBC) is typically managed with local therapy, including transurethral resection of bladder tumors (TURBT) and intravesical bacillus Calmette–Guérin (BCG) or chemotherapy. NMIBC has an excellent 5-year overall survival (OS) of 70 to 96%1. For muscle-invasive bladder cancer (MIBC), survival outcomes are significantly decreased and treatment, including cystectomy with perioperative chemotherapy or tri-modality therapy (TMT) that includes TURBT, chemotherapy, and radiation therapy, is more aggressive, whereas metastatic disease is generally managed with palliative systemic therapy and has a 5-year OS of about 5%1. Platinum-based chemotherapy has been the first-line treatment for metastatic bladder cancer for over 20 years. Since 2016, seven new agents have been approved by the US Food and Drug Administration (FDA) for locally advanced (LA) or metastatic urothelial carcinoma (mUC) and this has dramatically changed the treatment landscape. The aims of this review are to highlight these newly approved therapies and to discuss promising new treatment strategies for bladder cancer that are on the horizon
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