Urothelial Carcinoma: Optimal Treatment Options in First-Line and Beyond

For many years, the standard treatment approach in first-line for advanced urothelial carcinoma (UC) was platinum-based chemotherapy, with the choice of agent dependent on cisplatin-eligibility and relatively limited second-line therapy options included taxanes or vinflunine, thus although with miss...
Ausführliche Beschreibung

For many years, the standard treatment approach in first-line for advanced urothelial carcinoma (UC) was platinum-based chemotherapy, with the choice of agent dependent on cisplatin-eligibility and relatively limited second-line therapy options included taxanes or vinflunine, thus although with missing approval in Switzerland.^1^ In the last years, the treatment landscape has changed due to the emergence of new targeted approaches, including immune checkpoint inhibitors (ICIs).^2^ In Switzerland, programmed death-protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitors including pembrolizumab, atezolizumab and nivolumab are currently approved for the treatment of locally advanced or metastatic UC in adults having progressed on platinum-based chemotherapy,^3–5^ as well as pembrolizumab and atezolizumab in PD-L1 positive treatment naïve patients if platinum unfit. Evidence from a recent phase III trial has led to a new standard of care with a switch maintenance approach with the PD-L1 inhibitor avelumab for UC patients who are progression-free following platinum-based chemotherapy. Several novel emerging targeted therapies such as antibody-drug conjugates (ADC) or fibroblast growth factor receptor (FGFR) inhibitors are also being investigated in treatment-naïve as well as pretreated, platinum-and checkpoint inhibitor refractory patients with locally advanced or metastatic UC. This article provides an overview of current treatment options in first- and subsequent-line settings. Ausführliche Beschreibung