Programmed Death-1 and Programmed Death Ligand-1 Blockade for Advanced Urothelial Carcinoma

Immunotherapy with immune checkpoint inhibitors (ICIs) has changed the paradigm of anticancer therapy in many cancer types, including advanced urothelial carcinoma (UC). Two anti-programmed death-1 (PD-1) monoclonal antibodies (pembrolizumab and nivolumab) and three anti-PD ligand-1 (PD-L1) monoclonal antibodies (atezolizumab, durvalumab, and avelumab) have demonstrated their efficacy in the treatment of advanced UC. The response rate of the above ICIs in unselected patients with advanced UC is about 20%. Several on-going large-scale phase III studies explore whether different combinations with ICIs improve the efficacy. To date, there have been several phase I, II, and III studies that examined the efficacy of single-agent PD-1 or anti-PD-L1 blockade in platinum-failed advanced UC patients, and two phase II studies demonstrated the efficacy of PD-1/PD-L1 blockade as the first-line therapy in cisplatin-ineligible advanced UC patients. Here, we review and compare the efficacy and adverse events of the five ICIs in advanced UC.