ABSTRACT
Cisplatin-based chemotherapy is not effective in patients with advanced urothelial carcinoma. Recently, the application of immunological checkpoint inhibitors has brought new insight to resolve this problem. Since May 2016, five drugs, including Atezolizumab, Pembrolizumab, Nivolumab, Avelumab, and Durvalumab, targeting the PD-1/PD-L1 pathway have been approved by the FDA for the treatment of cisplatin-ineligible patients with advanced urothelial carcinoma, of which Pembrolizumab and Atezolizumab are the first-line drugs in the above treatments. The clinical efficacy and safety of these drugs are similar in different trials, but only Pembrolizumab is supported by a current level I evidence from a large randomized phase clinical trials. The results show that in the case of cisplatin ineligibility, Pembrolizumab is more effective than the traditional salvage chemotherapy in overall survival rate. Pembrolizuma is most effective in the treatment of cisplatin-ineligible patients with advanced urothelial carcinoma, while Pembrolizumab and Atezolizumab have similar efficacy in clinical applications of patients with cisplatin ineffective.