Onkológia 5/2024

Standard treatment of advanced urothelial carcinoma in first line

Since the 1970s, cisplatin has been the mainstay of treatment for advanced urothelial carcinomas, initially as monotherapy and later in combination primarily with gemcitabine. In the population of patients unfit for cisplatin (unfit criteria were accepted by consensus), a regimen of carboplatin with gemcitabine was established. A fundamental shift occurred in 2020, when an improvement in survival using maintenance immunotherapy (avelumab) was demonstrated in individuals who did not progress on induction chemotherapy based on a platinum derivative. At the ESMO 2023 congress, the results of two other important studies were presented. The first trial demonstrated improved survival with concomitant chemotherapy and immunotherapy (nivolumab) compared to chemotherapy alone. In the second study, an unprecedented improvement in therapeutic results using a conjugate (enfortumab vedotin) with immunotherapy (pembrolizumab), making this combination the new standard of first-line treatment, was showed.

Keywords: urothelial carcinoma, advanced disease, chemotherapy, immunotherapy, drug conjugate