Neoadjuvant Immunotherapy: The Next Gold Standard Before Radical Surgery for Urothelial Cancer

Cisplatin-based chemotherapy followed by radical cystectomy with bilateral pelvic lymph-node dissection is the current standard for cT2–4a N0 M0 urothelial bladder cancer. Immune checkpoint inhibitors have recently been tested in the neoadjuvant setting with promising pathological and survival results and a better safety profile. Excellent pathological responses have been observed, especially in cases with higher clinical T stage and PD-L1 expression, in addition to patients with selected gene signatures. In biomarker-selected patients, this manageable approach has the potential to become a new treatment option in the near future. Patient summary: For patients with bladder cancer invading the bladder wall muscle, platinum-based chemotherapy has been the standard treatment. Increasing evidence suggests that an alternative first treatment for this disease could be immunotherapy. Novel biomarkers and further studies are needed to support this approach before it can be used in everyday clinical practice.