Emerging role of immunotherapy in urothelial carcinoma—Advanced disease

Systemic therapy for metastatic urothelial carcinoma has seen minimal progress and no new approved therapies in the past 20 years. However, with the approval of the checkpoint inhibitor atezolizumab in May 2016, immunotherapy inserted itself into the standard clinical dogma. The emergence of systemic immunotherapies, heralded by drugs targeting immune checkpoint blockade, can provide durable remissions in a subset of patients with a favorable toxicity profile. With other similar agents showing promise in early-phase trials, more options may be on the way. Current and ongoing trials are investigating ways to increase response rates with rational combinations as well as to uncover predictive biomarkers to identify patients most likely to benefit. In this review, we present updated data regarding immunotherapeutic agents in clinical trials as well as ongoing studies investigating novel designs, intriguing combinations, and alternative immunotherapy strategies.