Urologic Malignancies

Immune checkpoint inhibitors (ICI) have revolutionized the care of urologic malignancies, in particular urothelial carcinoma (UC) and renal cell carcinoma (RCC). Five PD-1/PD-L1 ICIs have been approved for platinum-refractory advanced UC: atezolizumab, pembrolizumab, nivolumab, durvalumab, and avelumab. Atezolizumab and pembrolizumab have also been approved for cisplatin-ineligible advanced UC. For advanced RCC, nivolumab was the first ICI approved in the setting of prior antiangiogenic therapy. The ICI combination of nivolumab with ipilimumab has recently demonstrated improved overall response rate and overall survival in intermediate- and poor-risk patients with treatment-naïve, clear cell metastatic RCC (mRCC) and has become the standard of care. An ICI and vascular endothelial growth factor (VEGF)-targeted therapy combination, atezolizumab and bevacizumab, was randomized against sunitinib in the first-line treatment of mRCC, and this trial recently reported improvement of progression-free survival with the combination in a subset of patients. More ICI-ICI and ICI-VEGF inhibitor combinations are in clinical testing. The development of ICIs in prostate cancer has been challenging, and no ICIs are currently approved; however, progress is being made.