Pourquoi l'urologue doit s'intéresser à l'immunothérapie, quelles sont les indications établies en 2018 et celles en perspectives ?

Immunotherapy is an ancient concept in oncology, using the innate antitumoral immunity as an anti-cancer treatment. While the first immunotherapies stimulated globally the immune system with Interleukin or Interferon, “modern” immunotherapy consists in “lifting the brake” carried out by cancer cells on the antitumoral immunity. Two pathways allowing the tumor cell to escape antitumoral immunity have been identified: the PD1 and CTLA4 pathways. These are the targets of the main molecules recently tested in oncology. These specialties are administered IV every 2 to 3 weeks. Toxicities are generally inferior to “standard” chemotherapy. In France, only one immunotherapy received an agreement: Nivolumab (Anti-PD1) in second line after TKI in the treatment of metastatic renal cancer. Combinations of treatment (anti-CTLA4 + Anti-PD1 or immunotherapy and anti-VEGF treatment for kidney kidney) are definitely the future with many ongoing trials in uro-oncology, mainly for metastatic disease but also in adjuvant or neo-adjuvant situations.