Bladder-sparing treatment for muscle-invasive bladder carcinoma using immune checkpoint inhibitors

Multimodal bladder preservation therapy is already an alternative for patients with muscle-invasive bladder cancer (MIBC) who are unable or unwilling to undergo radical cystectomy. Various bladder-preserving strategies that employ immune checkpoint inhibitors (ICIs) for MIBC have been investigated. There are three common modes of ICI-based bladder preservation therapy, of which the most studied is ICIs combined with chemoradiotherapy. The bladder-preserving strategy of ICIs combined with radiation has been investigated in patients who poorly tolerate chemotherapy. ICIs combined with chemotherapy have also been explored in patients who responded to neoadjuvant therapy with a clinical complete response. All the above-described strategies have shown promising efficacy and manageable safety profiles. However, the value of programmed death-ligand 1 (PD-L1) expression, tumor mutation burden and gene alterations for predicting the efficacy of immune-based bladder preservation therapy is still controversial. There remain some challenges for immune-based bladder preservation therapy, and large-sample randomized trials are needed.

Automated summary

Multimodal bladder preservation therapy is an alternative treatment for patients with muscle-invasive bladder cancer who cannot or do not want to undergo radical cystectomy. Different strategies utilizing immune checkpoint inhibitors (ICIs) have been investigated, with ICIs combined with chemoradiotherapy being the most studied. This approach has shown promising efficacy and manageable safety profiles, especially in patients who poorly tolerate chemotherapy or respond to neoadjuvant therapy with a clinical complete response. However, the role of PD-L1 expression, tumor mutation burden, and gene alterations in predicting the efficacy of immune-based bladder preservation therapy is still controversial, and further randomized trials are needed.