AUTHOR=Nguyen Nam Phong , Karlsson Ulf Lennart , Page Brandi R. , Chirila Monica-Emilia , Vinh-Hung Vincent , Gorobets Olena , Arenas Meritxell , Mohammadianpanah Mohammad , Javadinia Seyed Alireza , Giap Huan , Kim Lyndon , Dutheil Fabien , Murthy Vedang , Mallum Abba Aji , Tlili Ghassen , Dahbi Zineb , Loganadane Gokoulakrichenane , Blanco Sergio Calleja , Bose Satya , Natoli Elena , Li Eric , Morganti Alessio G. TITLE=Immunotherapy and radiotherapy for older patients with invasive bladder cancer unfit for surgery or chemotherapy: practical proposal by the international geriatric radiotherapy group JOURNAL=Frontiers in Oncology VOLUME=14 YEAR=2024 URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2024.1371752 DOI=10.3389/fonc.2024.1371752 ISSN=2234-943X ABSTRACT=

The standard of care for non-metastatic muscle invasive bladder cancer is either radical cystectomy or bladder preservation therapy, which consists of maximal transurethral bladder resection of the tumor followed by concurrent chemoradiation with a cisplatin-based regimen. However, for older cancer patients who are too frail for surgical resection or have decreased renal function, radiotherapy alone may offer palliation. Recently, immunotherapy with immune checkpoint inhibitors (ICI) has emerged as a promising treatment when combined with radiotherapy due to the synergy of those two modalities. Transitional carcinoma of the bladder is traditionally a model for immunotherapy with an excellent response to Bacille Calmette-Guerin (BCG) in early disease stages, and with avelumab and atezolizumab for metastatic disease. Thus, we propose an algorithm combining immunotherapy and radiotherapy for older patients with locally advanced muscle-invasive bladder cancer who are not candidates for cisplatin-based chemotherapy and surgery.