Muscle-invasive bladder cancer(MIBC)is the predominant type of muscle-invasive urothelial carcinoma(MIUC).MIBC features an unfavorable prognosis with limited treatment approaches.The backbone of treatment strategy was neoadjuvant chemotherapy followed by radical cystectomy before 2021.Immunotherapy represented by nivolumab has gained breakthrough results in adjuvant setting,demonstrating significant improvement in disease free survival in high-risk MIUC population,and become a standard of care for MIUC adjuvant therapy since 2021.Immunotherapy has both efficacy and safety advantages compared to adjuvant chemotherapy.Predictors for adjuvant therapy response in MIUC have yet not been identified.The most evaluated predictive biomarkers to date for immune checkpoint inhibitor treatment response are programmed death ligand 1(PD-L1)expression and circulating tumour DNA(ctDNA),etc.Further research is crucial to assess the value of the biomarkers.Studies of perioperative immunotherapy combined with chemotherapy or antibody-drug conjugate are ongoing.Combined immunotherapy as part of bladder-sparing treatment regimen for MIUC is limited to small scale studies and has shown promising early outcomes.Further phase 3 clinical trials are underway to add mature data to bladder-sparing strategies incorporating immune checkpoint inhibitors in adjuvant setting.
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