Immunotherapy in non-metastatic urothelial cancer: back to the 'future'.

INTRODUCTION: Successful results of immuno-oncological drugs in metastatic urothelial cancer have triggered the interest of researchers to test them in the non-metastatic setting. Conventional treatment modalities in that space are limited, sometimes toxic and with no improvement seen for the last 20 years and beyond. For patients failing intravesical BCG and mitomycin C in non-muscle invasive bladder cancer, no effective therapeutic alternatives exist besides cystectomy. In the neoadjuvant setting, cisplatin-based chemotherapy provides limited benefit in terms of disease recurrence and metastases, at the expense of toxic effects. The good news is that preliminary studies are showing great promise with the use of immunotherapy in the local and loco-regional disease. Larger studies are now on the way to confirm the exciting potential benefits of immunotherapy in this direction. AREAS COVERED: This review presents an overview of developments happening on the introduction of immunotherapy in non-metastatic urothelial cancer treatment. EXPERT OPINION: Immunotherapy in the non-metastatic disease setting in urothelial cancer is evolving. Early results tend to anticipate a predominant role in coming times. Large comparative trials are in progress to gather robust practice-changing evidence to bring a paradigm shift in the treatment landscape.