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Neoadjuvant therapy in urothelial cancer - new therapies on the horizon

SummaryNeoadjuvant cisplatin-based chemother-apy is standard treatment for muscle-invasive blad-der cancer before radical cystectomy (RC). Despitelevel 1 evidence demonstrating an overall survivalbenefit for patients undergoing RC after neoadjuvantchemotherapy (NAC), acceptance rates are still low. Inhigh-risk upper tract urothelial cancer (UTUC), cumu-lative evidence suggests that NAC for locally advancedUTUC can improve oncological outcome. Ongoingphase 3 trials will finally prove the benefit or futilityof NAC in this tumor entity. Since urothelial cancer(UC) is a heterogeneous disease, predictive biomark-ers are needed to select specific patient populationsand potentially increase response rates to NAC. Noveltargeting therapies, including immune checkpointinhibitors, have been approved for metastatic UC. Incombination with predictive biomarkers, these mighthave the potential to change systemic therapy for UCfrom a “one-fits-all” principle to a more individualized approach.

urothelial cancer, neoadjuvant therapy

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