Immunotherapy for the Treatment of Urothelial Cancer

Publication Date: August 1, 2023
Last Updated: July 12, 2024

Summary of Recommendations

Diagnostic tests and biomarkers for urothelial cancer immunotherapy

  • Currently, the evidence does not support routine use of biomarkers to guide BCG therapy in NMIBC. Cystoscopy (with biopsy/transurethral resection (TUR) of bladder tumor as needed), urine cytology, and periodic upper tract imaging should be used to detect recurrence.

  • PD-L1 expression by IHC should be used to guide therapy in patients with mUC who are cisplatin-ineligible but eligible for carboplatin. Patients with PD-L1 negative tumors should receive carboplatin-based combination chemotherapy in this setting, while those with PD-L1 positive tumors can receive either immune checkpoint blockade or carboplatin-based chemotherapy (LE: 2). Clinical trial data otherwise does not currently support the use of PD-L1 expression to select patients with platinum-refractory disease for therapy.

  • MSI-H/dMMR testing should be considered in patients with upper tract and bladder urothelial cancer, especially for patients of younger age and/or with relevant personal or family history to rule out Lynch syndrome, which has implications for genetic counseling (LE: 3). The presence of MSI should not change the use of ICIs in advanced urothelial cancer.



Immunotherapy for the Treatment of Urothelial Cancer

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