Emerging first line treatment options for bladder cancer: a review of phase II and III therapies in the pipeline.
The treatment of urothelial carcinoma (UC) had remained unchanged for several years until the recent FDA approval of immune checkpoint inhibitors (CPIs) in the salvage setting. Novel dual CPI-CPI and CPI-chemotherapy combinations are now being investigated aggressively as first line therapy for metastatic disease. Areas covered: We discuss the recent insights into the tumor biology of UC, which may impact the prognosis as well as assist in developing precision medicine. This is followed by an overview of existing treatment including conventional chemotherapy as well as the trials that led to the recent approval of PD-1 and PD-L1 inhibitors. Ongoing phase II and phase III trials developing PD-1/PD-L1 inhibitors, CTLA-4 inhibitors and VEGF inhibitors as first-line therapy are discussed. Expert opinion: The treatment paradigm for the first-line therapy of UC is expected to shift from conventional platinum-based combination chemotherapy towards novel therapy incorporating CPI immunotherapy. Finding the right combination of drugs in the appropriate disease setting and identifying the right patient population based on biomarkers are important questions to be answered. Another major challenge will be the financial burden associated with these new drugs.
['Jamy|Omer|O|', 'Sonpavde|Guru|G|']
D000970:Antineoplastic Agents D014408:Biomarkers, Tumor D002295:Carcinoma, Transitional Cell D015195:Drug Design D006801:Humans D007167:Immunotherapy D018579:Patient Selection D011379:Prognosis D001749:Urinary Bladder Neoplasms
Bladder cancer urothelial carcinoma first line therapy PD-1 PD-L1 CTLA-4 VEGF bevacizumab platinum