Platinum-based chemotherapy has been the cornerstone for treating metastatic urothelial cancer, which compromises the majority of bladder cancer. While urothelial cancer is chemosensitive, patients often do not have a durable response and ultimately progress. Until recently patients were left with less effective second line chemotherapy options, but this has changed with the advent of immunotherapy. The United States Food and Drug Administration approved two programmed death-1 (PD-1) inhibitors and three programmed death ligand-1 (PD-L1) in 2016-2017 for the second line setting. Adding check point inhibitors to our armamentarium has been revolutionary, however there are opportunities to improve with strategies to increase response rates and apply immunotherapy to earlier disease stages.
1. Understand the current role of checkpoint inhibitors in metastatic urothelial cancer
2. Identify areas where immunotherapy could impact urothelial cancer treatment