English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

© Translational Andrology and Urology. All rights reserved. Patients with advanced or metastatic urothelial carcinoma are generally older and nephroureterectomy is frequently performed in such patients; therefore, cisplatin-based regimen often cannot be applied because of renal insufficiency and poor performance status. Gemcitabine and carboplatin is frequently used as combination chemotherapy for cisplatin-unfit patients and to reduce toxicities. Meanwhile, immune checkpoint inhibitors may be used to reduce toxicities without an efficacy compromise because immune checkpoint inhibitors are available regardless of renal function. The retrospective cohort study conducted by Feld et al. (1) clearly demonstrated inferior short-term but superior long-term survival with first-line immune checkpoint inhibitors relative to carboplatin-based chemotherapy among patients with metastatic urothelial carcinoma treated in routine clinical practice. Urothelial carcinoma is the sixth most common cancer in the United States, accounting for approximately 3% of cancer-related deaths (2). For advanced or metastatic urothelial carcinoma, platinum-based combination chemotherapy is the standard first-line treatment. In 1992, methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) was established as the first standard combination chemotherapy (3). Subsequently, gemcitabine and cisplatin (GC), which showed less adverse events and was as effective as MVAC, was recognized as the new standard combination chemotherapy in 2005 for advanced or metastatic urothelial carcinoma, and currently holds the same position (4). Unfortunately, after platinum-based chemotherapy, disease progression was frequently observed, and the overall survival (OS) rate at 2 years in patients treated with GC was only approximately 30%; moreover, most patients required a second-line treatment (5). The development of a better treatment strategy has been attempted in the past decade. Several molecular targeting agents and immune checkpoint inhibitors, such as programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) antibodies, have been tested to establish a standard second-line treatment (6,7). The KEYNOTE-045, phase 3 randomized-controlled trial revealed that the PD-1 antibody pembrolizumab significantly prolonged the OS of patients after platinumbased combination chemotherapy treatment (7). High tolerability and reduced adverse event frequency were noted during PD-1 and PD-L1 antibody treatment (8-11). Patients with advanced or metastatic urothelial carcinoma are generally older and nephroureterectomy is frequently performed in such patients; therefore, cisplatin-based regimen, such as MVAC and GC, often cannot be applied because of renal insufficiency and poor performance status. For such patients, immune checkpoint inhibitors may be used to reduce toxicities without an efficacy compromise because immune checkpoint inhibitors are available regardless of renal function (12,13). Hence, we reviewed multicenter studies reporting the use of immune checkpoint inhibitors as the first-line therapy for patients with advanced or metastatic urothelial cancer who are ineligible Editorial Commentary

First-line immune checkpoint inhibitors for patients with metastatic urothelial carcinoma treated in routine clinical practice