Immunotherapy with Checkpoint Blockade in the Treatment of Urothelial Carcinoma

Purpose: Although immunotherapy has a long history in the treatment of urothelial carcinoma, its use was limited to intravesical therapy for nonmuscle invasive disease. The development of immune checkpoint blockers for systemic delivery has expanded the application of immunotherapy to advanced metastatic urothelial cancers. Materials and Methods: The PubMed® database was searched for publications regarding immune checkpoint blockers for the treatment of patients with urothelial carcinoma. Relevant congress abstracts were identified through searches of individual congress websites. Results: A summary of the biology and immunology of urothelial carcinoma provides context to aid in discussing key data pertaining to immune checkpoint blockers that are approved and in development. We address immune mediated adverse events that are unique to immunotherapies and review diagnostic tools that may be useful to identify patients who would most benefit from immunotherapy. Conclusions: Immunotherapies for urothelial carcinoma have shown clinical efficacy in select patients as well as a manageable safety profile. Studies are ongoing with the aim of expanding the proof of efficacy in metastatic disease and providing additional treatment options for patients with earlier stages of urothelial carcinoma.