Onkologie. 2025:19(2):76-79 | DOI: 10.36290/xon.2025.016

Immunotherapy in the treatment of metastatic urothelial carcinoma

Martina Spisarová, Andrea Kopová
Onkologická klinika, Fakultní nemocnice Olomouc
Lékařská fakulta Univerzity Palackého v Olomouci

Urothelial carcinoma is one of the most common cancers in its early stages. Oncologists, however, more frequently encounter patients with advanced disease. Unresec­table or metastatic urothelial carcinoma remains a significant therapeutic challenge. Traditional treatment has long relied on platinum-based chemotherapy. In recent years, this approach has evolved with the introduction of checkpoint inhibitors. A breakthrough came with combination immunotherapy regimens involving antibody-drug conjugates. The combination of pembrolizumab and enfortumab vedotin has redefined first-line treatment recommendations for urothelial carcinoma. Combination therapy is poised to become the future of urothelial carcinoma management, mirroring trends seen in the treatment of other cancers.

Keywords: immunotherapy, urothelial carcinoma, bladder cancer, immune check­point inhibitors.

Accepted: April 25, 2025; Published: May 2, 2025  Show citation

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Spisarová M, Kopová A. Immunotherapy in the treatment of metastatic urothelial carcinoma. Onkologie. 2025;19(2):76-79. doi: 10.36290/xon.2025.016.
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References

  1. Morales A, Eidinger D, Bruce AW. Intracavitary Bacillus Calmette-Guerin in the treatment of superficial bladder tumors. J Urol. 1976;116(2):180-183. Go to original source... Go to PubMed...
  2. Balar AV, Kamat AM, Kulkarni GS, et al. Pembrolizumab monotherapy for the treatment of high-risk non-muscle-invasive bladder cancer unresponsive to BCG (KEYNOTE-057): an open-label, single-arm, multicentre, phase 2 study. Lancet Oncol. 2021;22(7):919-930. Go to original source... Go to PubMed...
  3. Bajorin DF, Witjes JA, Gschwend JE, et al. Adjuvant Nivolumab versus Placebo in Muscle-Invasive Urothelial Carcinoma. New England Journal of Medicine. 2021;384(22):2102-2114. Go to original source... Go to PubMed...
  4. Bellmunt J, Hussain M, Gschwend JE, et al. Adjuvant atezolizumab versus observation in muscle-invasive urothelial carcinoma (IMvigor010): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2021;22(4):525-537. Go to original source... Go to PubMed...
  5. Powles T, Park SH, Voog E, et al. Avelumab Maintenance Therapy for Advanced or Metastatic Urothelial Carcinoma. New England Journal of Medicine. 2020;383(13):1218-1230. Go to original source... Go to PubMed...
  6. Bellmunt J, de Wit R, Vaughn DJ, et al. Pembrolizumab as Second-Line Therapy for Advanced Urothelial Carcinoma. N Engl J Med. 2017;376(11):1015-1026. Go to original source... Go to PubMed...
  7. Tumeh PC, Harview CL, Yearley JH, et al. PD-1 blockade induces responses by inhibiting adaptive immune resistance. Nature. 2014;515(7528):568-571. Go to original source... Go to PubMed...
  8. Sternberg CN, Yagoda A, Scher HI, et al. Preliminary results of M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) for transitional cell carcinoma of the urothelium. J Urol. 1985;133(3):403-407. Go to original source... Go to PubMed...
  9. Balar AV, Castellano D, O'Donnell PH, et al. First-line pembrolizumab in cisplatin-ineligible patients with locally advanced and unresectable or metastatic urothelial cancer (KEYNOTE-052): a multicentre, single-arm, phase 2 study. Lancet Oncol. 2017;18(11):1483-1492. Go to original source... Go to PubMed...
  10. Balar AV, Galsky MD, Rosenberg JE, et al. Atezolizumab as first-line treatment in cisplatin-ineligible patients with locally advanced and metastatic urothelial carcinoma: a single-arm, multicentre, phase 2 trial. Lancet. 2017;389(10064):67-76. Go to original source... Go to PubMed...
  11. Galsky MD, Hahn NM, Rosenberg J, et al. Treatment of patients with metastatic urothelial cancer "unfit" for Cisplatin-based chemotherapy. J Clin Oncol. 2011;29(17):2432-2438. Go to original source... Go to PubMed...
  12. Grivas P, Grande E, Davis ID, et al. Avelumab first-line maintenance treatment for advanced urothelial carcinoma: review of evidence to guide clinical practice. ESMO Open. 2023;8(6):102050. Go to original source... Go to PubMed...
  13. Powles TB, Perez Valderrama B, Gupta S, et al. LBA6 EV-302/KEYNOTE-A39: Open-label, randomized phase III study of enfortumab vedotin in combination with pembrolizumab (EV+P) vs chemotherapy (Chemo) in previously untreated locally advanced metastatic urothelial carcinoma (la/mUC). Annals of Oncology. 2023;34:S1340. Go to original source...
  14. Powles T, Valderrama BP, Gupta S, et al. Enfortumab Vedotin and Pembrolizumab in Untreated Advanced Urothelial Can­cer. New England Journal of Medicine. 2024;390(10):875-888. Go to original source... Go to PubMed...
  15. Grande E, Birtle AJ, Kamat AM. Re: Thomas Powles, Begoña Pérez-Valderrama, Shilpa Gupta, et al. Enfortumab Vedotin and Pembrolizumab in Untreated Advanced Urothelial Cancer. N Engl J Med 2024;390:875-888. Eur Urol. 2024;86(6):e152-e153. Go to original source... Go to PubMed...
  16. van der Heijden MS, Sonpavde G, Powles T, et al. Nivolumab plus Gemcitabine-Cisplatin in Advanced Urothelial Carcinoma. N Engl J Med. 2023;389(19):1778-1789. Go to original source... Go to PubMed...
  17. Sharma P, Retz M, Siefker-Radtke A, et al. Nivolumab in metastatic urothelial carcinoma after platinum therapy (CheckMate 275): a multicentre, single-arm, phase 2 trial. Lancet Oncol. 2017;18(3):312-322. Go to original source... Go to PubMed...
  18. Powles T, Durán I, van der Heijden MS, et al. Atezolizumab versus chemotherapy in patients with platinum-treated locally advanced or metastatic urothelial carcinoma (IMvigor211): a multicentre, open-label, phase 3 randomised controlled trial. Lancet. 2018;391(10122):748-757. Go to original source... Go to PubMed...
  19. Rosenberg JE, Hoffman-Censits J, Powles T, et al. Atezolizumab in patients with locally advanced and metastatic urothelial carcinoma who have progressed following treat­ment with platinum-based chemotherapy: a single-arm, multicentre, phase 2 trial. Lancet. 2016;387(10031):1909-1920. Go to original source... Go to PubMed...
  20. Alhalabi O, Campbell M, Shah A, et al. Emerging treat­ments in advanced urothelial cancer. Curr Opin Oncol. 2020;32(3):232-239. Go to original source... Go to PubMed...
  21. Kawashima A, Ishizuya Y, Yamamoto Y, et al. Recent developments and future directions of first-line systemic therapy combined with immunotherapy for advanced or metastatic urothelial carcinoma: a historical perspective on treatment evolution. Int J Clin Oncol. 2024;29(8):1096-1104. Go to original source... Go to PubMed...
  22. Ascione CM, Napolitano F, Esposito D, et al. Role of FGFR3 in bladder cancer: Treatment landscape and future challenges. Cancer Treat Rev. 2023;115:102530. Go to original source... Go to PubMed...
  23. Albarrán V, Rosero DI, Chamorro J, et al. Her-2 Targeted Therapy in Advanced Urothelial Cancer: From Monoclonal Antibodies to Antibody-Drug Conjugates. Int J Mol Sci. 2022;23(20). Go to original source... Go to PubMed...
  24. Grivas P, Pouessel D, Park CH, et al. Sacituzumab Govitecan in Combination With Pembrolizumab for Patients With Metastatic Urothelial Cancer That Progressed After Platinum-Based Chemotherapy: TROPHY-U-01 Cohort 3. J Clin Oncol. 2024;42(12):1415-1425. Go to original source... Go to PubMed...
  25. Hoffman-Censits J, Grivas P, Powles T, et al. The JAVELIN Bladder Medley trial: avelumab-based combinations as first-line maintenance in advanced urothelial carcinoma. Future Oncol. 2024;20(4):179-190. Go to original source... Go to PubMed...




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