Integrating novel immunotherapeutic approaches in organ‐preserving therapies for bladder cancer

Abstract

Bladder cancer is a prevalent malignancy with significant morbidity and mortality. Over the years, the landscape of bladder cancer treatment has witnessed notable advancements, particularly in the realm of immunotherapy. Immunotherapy has emerged as a promising adjunct to organ‐preserving approaches, harnessing the immune system's potential to target and eliminate cancer cells.Organ preservation strategies offer viable alternatives to radical cystectomy to avoid the morbidities associated with radical surgery, as well as to respond to the needs of patients unfit for or who have refused surgery. However, the challenge lies in achieving durable disease control while minimizing treatment‐related toxicities. This review highlights the significance of immune checkpoint inhibitors, such as anti‐PD‐1/PD‐L1 antibodies, in the treatment of localized bladder cancer. The clinical efficacy of immune checkpoint inhibitors, both as neoadjuvant and adjuvant therapies in combination with radiation or chemotherapy, is discussed. Moreover, the potential of immunotherapies beyond immune checkpoint inhibition, including combinations with BCG instillations and/or investigational gene therapies, is explored. Furthermore, the predictive value of the tumor immune microenvironment for the success of these strategies is examined. Understanding the complex interplay between tumor immunity and therapeutic interventions can aid in identifying predictive biomarkers and tailoring personalized treatment strategies. Further research and clinical trials are warranted to optimize the use of immunotherapy in conjunction with organ‐preserving therapies, potentially leading to enhanced patient outcomes and quality of life.