ICIs in Urological malignancies

Dear All,

Recently Immune Checkpoint Inhibitors (ICIs) are coming to the fore in the treatments of all Advanced Urological Malignancies from Kidney to GCTs. Hence a good knowledge of the various ICIs now available has become a necessity.

 Though they evolved for treatment as 2nd line (even 3rd line), recently many of them are finding its place in primary treatments. On many occasions it was originally used as an Adjuvant regime but recently these are used as Neoadjuvant as well. In RCC and MIBC they have received the status of first line therapy. Recently, it is being planned for treatments of BCG Unresponsive NMIBC as well.

But all is not rosy as regards use of ICIs. In many the response to treatments with ICIs are not effective and the treatments may have to be discontinued. Different PD-L1/PD-1 antibodies have been approved for use as biomarkers for immune checkpoint blockade in various malignancies, including the genitourinary malignancies. PD-L1 Immunohistochemical testing has been widely used across the globe as a biomarker for immunotherapy. Positivity and negativity play an important role to assess the effectiveness of these drugs. Additionally there are other Biomarkers as well that will help prediction of response to ICIs.

I am providing a review article addressing this issue as to when and how for using ICIs in Urological malignancies.

We have to move with time and understanding the various nuances concerning ICIs have become a reality.

With warm regards,

Venu

 

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