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For  a  long  time,  chemotherapy  remained  the  main  treatment  option  for  metastatic  urothelial  carcinoma (mUC). Over the past year, there have been revolutionary changes associated with the approval of five new drugs aimed at blocking the interaction between the surface protein of T‑lymphocytes PD‑1 and its ligands PD‑L1 and PD‑L2,  resulting  in  the  activation  of  the  immune  response.  It  is  noteworthy  that  the  anti‑PD‑1  antibody pembrolizumab demonstrated an increase in overall survival relative to chemotherapy in a randomized phase III trial in the second line with mUC. Based on this level 1 evidence pembrolizumab was approved by the US Food and Drug Administration (FDA). Nivolumab (antibody PD‑1) also demonstrated an increase in overall survival compared  to  historical  control  and  was  approved  by  FDA.  Likewise,  antibodies  targeting  PD‑L1,  including atezolizumab,  durvalumab  and  avelumab,  received  accelerated  approval  from  the  FDA  as  the  second  line  of treatment for mUC. Some of these agents are approved in the first line by the results of phase II study (atezolizumab and  pembolizumab  received  accelerated  approval  for  first‑line  treatment  in  patients  not  receiving  cisplatin). Despite these many endorsements, clinical development of new biomarkers for selection of patients, who can get maximum advantages of immunotherapy and also for development the optimal therapy sequencing still are biggest and critical question for future investigation.The  clinical  introduction  of  biomarkers  to  determine  optimal  treatment  of  patients  remains  extremely important.

DERN CONTROL POINT INHIBITORS AND THEIR POSSIBILITIES FOR THE THERAPY OF METASTATIC UROTELIAL CANCER