Current treatment options and future perspectives on first line metastatic bladder cancer

OBJECTIVE: Over the last 30 years research on metastatic bladder cancer has been slow and limited to chemotherapy. Chemotherapy has provided high initial response rates but very few complete responses that remain overtime. Recently, European medical agency has granted approval to immunotherapy in metastatic disease. We will review the clinical trials that drove to EMA approval as well as new promising therapies for metastatic bladder cancer. METHODS: A search on PubMed and clinicaltrials. goy through the combination of the following words in English and Spanish was performed: "carcinoma urotelial", "cancer de vejiga", "localmente avanzado", metastasico", "inmunoterapia", "CTIA-4", "PD 1", "PDL-1", "atezolizumab", "nivolumab", "ipilimubab", "pembrolizumab", "avelumab", "durvalumab", "tremelimumab", "terapia antiangiogenica", "terapia molecular dirigida" e "inhibidores VEGF". RESULTS: Cisplatin chemotherapy-based regimens remain standard treatment for metastatic bladder cancer as per phase III trials. Immunotherapy is available for cisplatin-ineligible patients with high PD-L1 expression, including atezolizumab or pembrolizumab. Trials comparing immunotherapy, chemotherapy or antiangiogenic drugs o targeted drugs are recruiting. CONCLUSIONS: The publication of the comparative studies on chemotherapy and immunotherapy as well as targeted therapy would provide a window of opportunity for an effective personalized treatment. Those treatment would decrease side-effects as well.