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SAGE Publications, Therapeutic Advances in Urology, (11), p. 175628721983928, 2019

DOI: 10.1177/1756287219839285

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Pembrolizumab in the treatment of locally advanced or metastatic urothelial carcinoma: clinical trial evidence and experience

Journal article published in 2019 by Michael Crist, Gopa Iyer, Miles Hsu, William C. Huang, Arjun V. Balar ORCID
This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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Abstract

The treatment of advanced urothelial carcinoma (UC) has dramatically changed with the advent of immune checkpoint inhibitors that disrupt the T-cell inhibitory interaction between the programmed cell death (PD)-1 receptor and its ligand (PD-L1). Pembrolizumab, a highly specific, monoclonal antibody directed against PD-1, has demonstrated clinical efficacy as well as a favorable toxicity profile, and has emerged as a new standard of care in the treatment of advanced UC. This review will summarize clinical efficacy from recent trials that led to the approval of pembrolizumab in treating platinum-refractory advanced UC as well as treating patients who are ineligible for first-line cisplatin-containing chemotherapy. While immune checkpoint inhibition has reinvigorated the treatment landscape of advanced UC and generated a great deal of optimism, only a minority of patients benefit. Combination strategies with the goal of increasing response rates are desperately needed as are biomarkers predictive of response.