Treatment of metastatic bladder cancer: current and historical aspects

The “state-of-art” treatment approach for patients with metastatic urothelial cancer (eg, bladder cancer or other urothelial tumors of urinary tract) is platinum-containing chemotherapy, however, despite the high immediate efficacy of therapy (up to 70% of the objective response rate), long-term results of treatment remain unsatisfactory, median progression-free and overall survival usually do not exceed 6 and 12 months respectively, patients with visceral metastases or poor performance status have a particularly dismal prognosis. The most effective treatment for this disease is cisplatin-containing chemotherapy, ddMVAC (methotrexate, vinblastine, doxorubicin, cisplatin) and GC (gemcitabine, cisplatin) regimens are most effective, however, in real world setting a minority of patients can tolerate these treatment options. Recent advances in the treatment of urothelial cancer are associated with discoveries in the field of immunotherapy for this disease by targeting the PD-1/PD-L1 pathway. The most promising results in the first line of treatment for this disease based on the sequential use of cisplatin-containing chemotherapy with maintenance avelumab therapy, the latter drug has been proven to increase the overall survival of patients with metastatic urothelial cancer. This article discusses key data on the immediate and long-term effectiveness of systemic therapy for metastatic urothelial cancer, as well as potential ways to improve the results of treatment of patients with this disease, primarily through the introduction of maintenance immunotherapy into real world clinical practice and expanding the category of patients who are eligible for platinum-containing chemotherapy.