Combination immunotherapy in metastatic urothelial cancer: time for the next step?
Over the past 40 years, cisplatin-based chemotherapy has remained the standard of care for metastatic urothelial carcinoma (mUC) (1). However, inadequate renal function and poor performance status preclude the use of platinum-based regimens in approximately 50% of patients with mUC (2). Moreover, until recently, second line chemotherapy has provided modest benefit in patients who experience disease progression following first line treatment. Nevertheless, since 2016, the approval of immune checkpoint inhibitors (ICIs) for the treatment of mUC has marked a therapeutic renaissance for systemic treatment of mUC. Indeed, five agents have received FDA approval for platinum-refractory disease; among them, pembrolizumab and atezolizumab have been also approved for cisplatin-unfit patients in the frontline setting (3-8).