Abstract
Urothelial cancer is the most common histological type of bladder cancer. The standard of the treatment of non-invasive urothelial cancer is transurethral resection with possible installation of chemotherapy or Bacillus Calmette-Guerin (BCG) vaccine.
The curative therapy for non-metastatic invasive urothelial cancer is radical cystectomy combined by neoadjuvant chemotherapy based on cisplatin. In patients where radical cystectomy is not possible, a maintenance protocol is indicated.
Chemotherapy based on cisplatin is the basis of systemic treatment of locally advanced or metastatic urothelial cancer. Regimens without cisplatin administration have worse treatment outcomes.
In recent years, systemic therapy has been further developed. Bladder urothelial carcinoma is among the tumors that can be treated by immunotherapy.
The checkpoints inhibitors of the immune response showed the greatest benefit. In the treatment of metastatic urothelial cancer checkpoints inhibitors can be indicated both in patients who have previously received platinum-based chemotherapy, and in the first line in patients unable to undergo platinum-based chemotherapy.
A more recent approach is the concept of maintenance immunotherapy after prior administration of platinum-based chemotherapy. Furthermore, new tyrosine kinase inhibitors or conjugated molecules are also entering the treatment strategy.
The problem is the ambiguity of the predictive factors of immunotherapy.