Combining Radiotherapy with Immune Checkpoint Inhibitors for the Management of Muscle-Invasive Bladder Cancer: A Comprehensive Systematic Review from the Y-ECI ROSC EORTC group.

Abstract

Objective: This review aims to evaluate the efficacy and safety of combining immune checkpoint inhibitors (ICI) with RT in the treatment of non-metastatic MIBC, focusing on neoadjuvant and bladder preservation strategies.

Evidence acquisition: A systematic literature review was conducted from January 2000 to December 2023 using PubMed and Clinicaltrials.gov databases. Studies investigating outcomes after combining immunotherapy with RT for non-metastatic MIBC were selected. Data extraction included study identifiers, patient characteristics, intervention and control arm details, and primary outcomes.

Evidence synthesis: Among 28 selected studies, diverse approaches were observed, including neoadjuvant and bladder preservation strategies. Neoadjuvant trials, such as RACE IT, explored the feasibility of combining ICI with RT before radical cystectomy, showing promising efficacy and safety outcomes. In bladder preservation strategies, completed as well as ongoing trials demonstrated acceptable toxicity profiles and promising early efficacy data for combining ICI with chemoradiotherapy or RT alone.

Conclusion: Combining ICI with RT holds significant promise as a treatment strategy for non-metastatic MIBC. Preliminary evidence suggests favorable efficacy and safety profiles, supporting further exploration and potential integration into standard care. Ongoing phase III trials will provide crucial insights into the comparative effectiveness of adding ICI to conventional definitive treatments. In the evolving landscape of MIBC management, the combination of ICI and RT has the potential to reshape therapeutic paradigms and improve outcomes for patients.