Immunotherapy for urothelial carcinoma in an expanded patient population: bridging the gap between clinical trials and real-world practice

This article reviews the use of immunotherapy for the treatment of advanced urothelial carcinoma in an expanded patient population reflecting real-world clinical practice. It also describes two clinical cases of atezolizumab in second line treatment. Based on the analysis of the global Phase IIIb SAUL study, the multicenter Russian AURORA-RU study, and the own data, it was demonstrated that the PD-L1 (programmed death-ligand 1) inhibitor atezolizumab provides durable responses, long-term survival, and good tolerability even in “challenging” patient categories: elderly patients, comorbid patients, and patients with impaired renal function. The first clinical observation demonstrates the efficacy of atezolizumab in a 59-year-old patient with severe concomitant pathology and massive disease generalization following progression on platinum-based intra-arterial chemotherapy. A pseudoprogression is described: by applying iRECIST criteria and considering clinical stability, therapy was continued, leading to disease control for 21 months. The second clinical case illustrates the experience of treating a 72-year-old patient with chronic kidney disease and progression on platinum-based regimen. Treatment with atezolizumab resulted in achieving a significant partial response (44 % regression of the target lesion) and stabilization of bone metastases while maintaining a high quality of life throughout 27 months of treatment. In real-world clinical practice, atezolizumab is a preferred strategy for second line therapy, enabling durable responses and good tolerability even in patients with comorbidities.