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Immune checkpoint inhibitors such as atezolizumab and pembrolizumab improve outcomes in cisplatin-ineligible patients. Nivolumab has FDA-adjuvant approval for high-risk muscle-invasive urothelial cancer after the Checkmate 274 trial. The review describes current clinical applications and future directions supported by ongoing trials.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/recent-advances-in-immunotherapy-for-bladder-cancer-treatment/373109/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/recent-advances-in-immunotherapy-for-bladder-cancer-treatment/373109.png","ImageObject",300,407,{"name":92,"@type":93},"Miles","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",14,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is cisplatin-based chemotherapy often not suitable for all bladder cancer patients?","Question",{"text":113,"@type":114},"Many patients are ineligible due to factors such as age, renal impairment, or frailty, which limits standard cisplatin-based neoadjuvant or metastatic therapy.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How do checkpoint inhibitors contribute to bladder cancer treatment?",{"text":118,"@type":114},"Checkpoint inhibitors such as atezolizumab and pembrolizumab enhance survival, especially for cisplatin-ineligible patients, by strengthening anti-cancer immune responses.",{"name":120,"@type":111,"acceptedAnswer":121},"What role does nivolumab play in muscle-invasive urothelial cancer?",{"text":122,"@type":114},"Nivolumab was approved as second-line therapy and later by the FDA for adjuvant treatment of high-risk muscle-invasive urothelial cancer following the Checkmate 274 trial, including settings after resection and for cisplatin ineligibility.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},373109,1790269611,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":46},13056703019404,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","Review began 02/08/2025  \nReview ended 02/13/2025  \nPublished 02/14/2025  \n© Copyright 2025  \nAlqarni. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.79002  \nOpen Access Review Article  \nRecent Advances in Immunotherapy for Bladder Cancer Treatment  \nKhaled A. Alqarni 1  \n1. Department of Surgery, Faculty of Medicine, University of Jeddah, Jeddah, SAU Corresponding author: Khaled A. Alqarni, [alqarni.khaled@hotmail.com](alqarni.khaled@hotmail.com)  \nAbstract  \nBladder cancer is one of the most common malignancies worldwide. Standard neoadjuvant or metastatic therapy used to be cisplatin-based chemotherapy, but many patients are ineligible due to age, renal impairment, or frailty. Checkpoint inhibitors (e.g., atezolizumab and pembrolizumab) enhance survival incisplatin-ineligible patients. Originally approved as second-line therapy for patients after platinum-based chemotherapy, nivolumab was approved by the FDA for adjuvant therapy of high-risk muscle-invasive urothelial cancer following the Checkmate 274 trial. It is indicated for patients with resected disease orcisplatin ineligibility. Recent developments focused on the contribution of nivolumab to outcomes have been complemented by ongoing investigations on atezolizumab as a monotherapy or in combinations for muscle-invasive bladder cancer, providing further hope for improved control.  \nThis narrative review aims to clarify the current applications of immunotherapy in treating bladder cancer and to explore the future outlook based on ongoing clinical trials.  \nCategories: Urology, Medical Education, Oncology  \nKeywords: atezolizumab, bladder cancer, immunotherapy, nivolumab, urothelial carcinoma  \nIntroduction And Background  \nAround 200,000 people die each year from bladder cancer, the 12th most common malignancy in the world [1,2] . According to studies, men are more likely to develop bladder cancer [3] . Transurethral resections are a standard treatment for superficial bladder cancer. However, most cases have a high recurrence rate and are not muscle-invasive [4] . When diagnosed, over 75% of bladder cancer patients had non-muscle-invasive bladder cancer (NMIBC) . These can be successfully treated using conservative local treatments and careful surveillance [4] .  \nTwenty-five percent have muscle-invasive disease, typically requiring cystectomy, radiotherapy, or palliative treatment [5,6] . Muscle-invasive bladder cancer (MIBC), on the other hand, is a more aggressive form of bladder cancer that requires local treatments like radical cystectomy and radio chemotherapy to achieve a curative outcome [7] . Localized MIBC patients have a survival rate of 70% over five years. Patients with lymph node involvement have a 39% survival rate [8] . Patients with distant metastases, however, have an 8.8% survival rate [9] .  \nUrothelial carcinoma (UC) is responsive to chemotherapy and can be administered alongside radical cystectomy. It serves as neoadjuvant treatment, offering a 5% increase in survival rates, or as adjuvant therapy for localized disease or lymph node involvement, which provides a 10% survival advantage [7] . Approximately 40% of patients experience recurrence or metastasis following radical cystectomy [10, 11]. Furthermore, 10-15% of UC patients present with metastatic disease at diagnosis [12]. In the absence of treatment, the median survival for metastatic UC is only three to six months [13]. By the time of death, nearly all UC patients show extensive and often symptomatic metastasis [12].  \nOur immune system can identify and destroy any potentially harmful cells. T cells are specifically trained to search our bodies for malignant cells. Most advanced cancer patients do not develop anti-cancer immunity or are suppressed due to the cancer’s m","cbCaipcwDfArgr4a","https://ap.wps.com/l/cbCaipcwDfArgr4a","pdf",706543,"English","# Abstract\n# Introduction And Background\n## Epidemiology and disease spectrum\n## Survival outcomes by stage\n## Role of urothelial carcinoma and treatment settings\n## Immune system mechanisms and rationale for immunotherapy\n## Immune checkpoints and therapeutic targets\n## BCG therapy and checkpoint inhibitors in bladder cancer","[{\"question\":\"Why is cisplatin-based chemotherapy often not suitable for all bladder cancer patients?\",\"answer\":\"Many patients are ineligible due to factors such as age, renal impairment, or frailty, which limits standard cisplatin-based neoadjuvant or metastatic therapy.\"},{\"question\":\"How do checkpoint inhibitors contribute to bladder cancer treatment?\",\"answer\":\"Checkpoint inhibitors such as atezolizumab and pembrolizumab enhance survival, especially for cisplatin-ineligible patients, by strengthening anti-cancer immune responses.\"},{\"question\":\"What role does nivolumab play in muscle-invasive urothelial cancer?\",\"answer\":\"Nivolumab was approved as second-line therapy and later by the FDA for adjuvant treatment of high-risk muscle-invasive urothelial cancer following the Checkmate 274 trial, including settings after resection and for cisplatin ineligibility.\"}]","Recent Advances in Immunotherapy for Bladder Cancer Treatment | PDF",1790196877]