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Efficacy and safety of atezolizumab in the treatment of urothelial carcinoma: a systematic review and meta-analysis

World Journal of Surgical Oncology volume 23, Article number: 133 (2025) Cite this article

Abstract

Background

There is still controversy regarding the safety and efficacy of atezolizumab for the treatment of urothelial carcinoma (UC). This research aimed to extensively investigate the effectiveness and safety of atezolizumab as a therapy for UC.

Methods

A thorough literature review was conducted using databases including PubMed, Embase, the Cochrane Library, and Web of Science. The search included studies published from the inception of each database until May 24, 2024. The primary outcomes, progression-free survival (PFS) and overall survival (OS), were calculated using hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs).

Results

Ten randomized controlled trials (RCTs) totaling 4,148 participants were included in our analysis. Compared to UC patients who received a placebo, either alone or in combination with chemotherapy medications, aggregated data showed that patients with UC who received atezolizumab had significantly longer OS(HR = 0.88, 95% CI [0.83, 0.94], p < 0.0001). Three RCTs also provided data on PFS, showing that patients who received atezolizumab, either in addition to or instead of chemotherapy, had significantly longer PFS than those who received placebo with or without chemotherapy (HR = 0.85, 95% CI [0.76, 0.95], p = 0.004).

Conclusions

Atezolizumab has demonstrated significant improvements in OS and PFS among patients with UC, offering crucial insights for decision-making in UC immunotherapy.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier [CRD42024556757].

Introduction

Urothelial carcinoma (UC) is the second-fastest growing genitourinary malignancy in males and ranks as the tenth most common cancer overall. Research has identified several primary risk factors for the development of UC, including advanced age, cigarette smoking, exposure to chemical pollutants, and contact with carcinogens [1]. Approximately 80% of patients are diagnosed between the ages of 50 and 80 years, and the incidence of this condition is approximately three to four times higher in men than in women [2]. Metastatic urothelial carcinoma (mUC) has a particularly poor prognosis, with an overall five-year survival rate of less than 5%. Currently, the mainstay of treatment for mUC is combination chemotherapy with cisplatin; however, this treatment is often ineffective in the long term and frequently leads to recurrence, significantly reducing patient survival rates [3]. Therefore, identifying effective therapeutic strategies for UC remains a significant clinical challenge.

Recent efforts have focused on enhancing the effectiveness of UC treatment by integrating additional medications. However, research on the efficacy of alternative combination therapies remains limited. Immune checkpoint inhibitors (ICIs), which modulate immune responses, have emerged as a promising focus of current studies. The primary role of tumor cell-associated immune checkpoint molecules, such as programmed cell death ligand-1 (PD-L1), is to facilitate immune evasion [4]. PD-L1 binds to its receptor, programmed cell death-1 (PD-1), which is commonly expressed by activated T cells under prolonged stimulation conditions, such as infection or cancer [5]. This interaction can inhibit T cell proliferation or directly induce T cell apoptosis, ultimately leading to T cell inactivation or reduction. Additionally, PD-L1 can bind to the B7-1 receptor on antigen-presenting cells, suppressing the immune response by reducing T cell activation and cytokine production [6]. Consequently, the presence of PD-L1 in tumor cells can enable immune evasion, impeding the body’s immune response to the tumor [7].

Atezolizumab, a novel PD-L1/PD-1 inhibitor, targets the binding of PD-L1 to its receptor, thereby inhibiting the interaction between PD-L1 and PD-1 [8]. Clinical trials have demonstrated promising efficacy of atezolizumab in various cancers, including lung [9], liver [10], kidney [11], cervical [12], breast [13], ovarian [14], penile [15], colorectal [16], pancreatic [17], esophageal [18], and lymphoma [19]. Preliminary findings suggest that atezolizumab may improve patient symptoms, slow disease progression, and exhibit favorable clinical efficacy and safety in UC. For instance, Bamias et al. [20] conducted a trial comparing 360 patients receiving atezolizumab monotherapy to 360 patients receiving placebo plus platinum-based chemotherapy. The study found that atezolizumab monotherapy was superior in terms of both survival outcomes and adverse events. Similarly, Grande et al. [21] reported that atezolizumab effectively extended the survival time of patients with UC while minimizing negative side effects, demonstrating a positive therapeutic outcome compared to traditional chemotherapeutic agents.

Despite promising results from several clinical trials, the safety and efficacy of atezolizumab in treating UC remain under ongoing debate. Comprehensive data synthesis regarding the effectiveness of this drug in UC treatment has yet to be fully established. Therefore, the objective of our paper is to integrate clinical data from relevant existing studies using systematic review and meta-analysis to provide the most current and comprehensive evidence-based assessment that verifies the effectiveness and safety of atezolizumab in UC.

Materials and methods

Literature search

The study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. The research protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42024556757). Two researchers, XJ and MQY, independently developed the search strategy. They generated subject terms and keywords to search multiple databases, including PubMed, Embase, Web of Science, and the Cochrane Library, from their inception to 24 May 2024. MESH terms were used in the search, including “Carcinoma, Transitional Cell,” “Carcinomas, Transitional Cell,” “Cell Carcinomas, Transitional,” “Cell Carcinoma, Transitional,” “Transitional Cell Carcinoma,” “Transitional Cell Carcinomas,” “Urinary Bladder Neoplasms,” “Neoplasm, Urinary Bladder,” “Urinary Bladder Neoplasm,” “Bladder Neoplasms,” “Bladder Neoplasm,” “Neoplasm, Bladder,” “Bladder Tumors,” “Bladder Tumor,” “Tumor, Bladder,” “Tumors, Bladder,” “Neoplasms, Bladder,” “Urinary Bladder Cancer,” “Cancer, Urinary Bladder,” “Bladder Cancer,” “Bladder Cancers,” “Cancer, Bladder,” “Cancer of Bladder,” “Cancer of the Bladder,” “Malignant Tumor of Urinary Bladder,” and “atezolizumab.” Literature search methods are listed in Supplementary Table S1.

Study selection

The following inclusion criteria were applied to select studies for our analysis: (1) Participants: Studies included patients with UC diagnosed by pathological observation. (2) Intervention and Comparison: The control group did not receive atezolizumab, while the intervention group received atezolizumab either as monotherapy or in combination with other therapies. (3) Outcomes: The trials assessed survival and safety outcomes of atezolizumab in UC patients, including OS, PFS, disease-free survival(DFS), and recurrence-free(RFS). (4) Studies: Studies provided HR and 95% CI, either directly reported or calculated from available data. Only fully published studies were included.

Exclusion criteria were as follows: (1) Letters, case reports, conference abstracts, reviews, commentaries, and animal studies were excluded. (2) Studies lacking sufficient details to determine HR and 95% CI were excluded. (3) Studies without survival data were excluded. (4) Research with overlapping or duplicate data was excluded. (5) Studies with incomplete or inaccurate outcome measures that could not be obtained from the original authors were excluded.

Two researchers, XJ and MQY, independently reviewed the titles and abstracts of publications retrieved from databases. After downloading the full-text papers, they evaluated them for eligibility. Any disagreements during the study selection process were resolved through consensus.

Data extraction

Two researchers, XJ and MQY, independently supervised the data extraction process. Any disagreements were resolved through discussion among all coauthors to reach a consensus. The extracted information included the following details: the first author’s name, publication year, country (study site), study type, registration code, study population characteristics, treatment modality, sample size, follow-up duration, mean age, proportion of males, and HR with 95% CI for OS and PFS.

Quality assessment

Two investigators (XJ and MQY) independently evaluated the methodological quality of the relevant RCTs using the Cochrane risk of bias assessment tool. They cross-verified their assessments based on seven components: completeness of outcome data, selective reporting bias, blinding of participants and outcome assessors, allocation concealment, random sequence generation, and other potential biases [22]. Studies were categorized into three groups: “high risk of bias,” “low risk of bias,” and “unclear risk of bias.” In cases of disagreement between the two investigators, a third researcher (CJH) was consulted to reach a final decision [23].

Statistical analysis

The HR and 95% CIs were calculated to assess the predictive relevance of OS and PFS in patients with UC who received atezolizumab therapy. Heterogeneity was evaluated using Cochran’s Q test and Higgins I2 statistic. Significant heterogeneity was indicated when I2>50% or the Cochran’s Q test P value was <0.1. Data synthesis was conducted using a random effects model. Additionally, subgroup and sensitivity analyses were performed to verify the robustness of the OS and PFS outcomes and to explore potential sources of variability. Funnel plots and Egger’s test were used to assess publication bias. Statistical significance was defined as a p-value of < 0.05. All statistical analyses were performed using STATA 15.1 and Review Manager 5.4 software.

Results

Study characteristics

Following the initial search, the database contained 1,333 entries. Of these, 409 duplicate articles were removed. After evaluating the titles and abstracts of the remaining publications, we excluded a total of 910 studies that did not meet our inclusion criteria. The full texts of 14 articles were then assessed for eligibility. Four studies were subsequently excluded primarily due to insufficient data necessary for statistical analysis of survival outcomes. Consequently, the final meta-analysis included 10 trials involving 4,148 participants (Fig. 1). Among the ten eligible studies, three were conducted in the United States, one in Japan, and six in European countries. Notably, all ten studies were RCTs published in English between 2018 and 2024. Each RCT comprised two groups: a control group receiving placebo with or without chemotherapeutic agents, and an intervention group receiving atezolizumab with or without chemotherapeutic agents. All ten trials evaluated the prognostic significance of atezolizumab on OS and PFS. Table 1 summarizes the key characteristics of the ten studies included in this meta-analysis.

Fig. 1
figure 1

Flow chart of literature screening

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Table 1 Basic characteristics of the included literature
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Bias risk assessment results

The Cochrane Risk of Bias Assessment Tool was utilized to evaluate the reliability of the included studies. The stratified permutation block randomization method was employed for allocating all ten studies, which were initially assessed as having a low risk of bias. However, three studies adopted an open-label design and were consequently categorized as having a high risk of bias due to potential performance and detection biases. Additionally, three studies lacked explicit information regarding blinding and allocation concealment processes, leading to an unclear risk classification. Four studies implemented adequate blinding procedures for allocation concealment and were classified as low risk. Of these four studies, two did not provide sufficient endpoint information, resulting in an unclear risk classification. The remaining six studies provided complete outcome data and were classified as low risk. After registration and evaluation for selective reporting, all trials were confirmed to have a low risk of bias. Finally, no other sources of bias were identified for the ten studies, which were consistently classified as low risk overall (Fig. 2).

Fig. 2
figure 2

(A): Risk of bias graph; (B): Risk of bias summary

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Survival outcomes

Overall survival (OS)

The results of the ten studies included in this meta-analysis demonstrated a strong and statistically significant positive association between the use of atezolizumab, with or without chemotherapeutic agents, and an increase in OS among patients with UC. Compared to patients treated with placebo, with or without chemotherapeutic agents, the HR was 0.88(95%CI [0.83, 0.94], I2 = 0%, p < 0.0001) (Fig. 3A).

Fig. 3
figure 3

(A) OS Forest plots; (B). PFS Forest plots

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Subgroup analyses were conducted based on study population characteristics. Among individuals of European ethnicity, atezolizumab significantly improved OS (HR = 0.86, 95%CI [0.80, 0.93], p < 0.0001), with no heterogeneity observed (I2 = 0%). However, atezolizumab did not have a significant impact on OS in the American and Asian subgroups. Specifically, in the American subgroup, the HR was 0.90 (95%CI [0.79, 1.02], p = 0.1), while in the Asian subgroup, the HR was 1.13 (95%CI [0.84, 1.52], p = 0.42). Notably, there was low heterogeneity within the American population (I2 = 15%).

Subgroup analyses were also performed based on treatment modality. Both atezolizumab monotherapy (HR = 0.90, 95%CI [0.83, 0.98], p = 0.02) and atezolizumab in combination with chemotherapeutic agents (HR = 0.84, 95%CI [0.75, 0.94], p = 0.002) were effective in extending OS. However, there were notable differences in heterogeneity between the two treatment options: atezolizumab monotherapy (I2 = 14%) versus atezolizumab combined with chemotherapy (I2 = 0%) (Table 2).

Table 2 Subgroup analysis of Atezolizumab versus chemotherapy for urothelial carcinoma
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Progression-free survival (PFS)

The PFS results from three trials corroborated the conclusions drawn from our OS analysis. These studies demonstrated that patients with UC receiving atezolizumab, either as monotherapy or in combination with chemotherapeutic agents, had significantly longer PFS compared to UC patients receiving placebo with or without chemotherapeutic agents (HR = 0.85, 95%CI [0.76, 0.95], p = 0.004, Fig. 3B). Additionally, there was a moderate degree of heterogeneity among the studies (I2 = 10%, p = 0.004). The findings indicate that administering atezolizumab, either alone or in conjunction with chemotherapeutic drugs, led to a significant extension of PFS in patients.

Sensitivity analysis

Sensitivity analyses were conducted to assess the stability of both OS and PFS. The results indicated that, for OS, there was no significant change in the statistical significance after excluding each individual study. However, for PFS, the statistical significance exhibited substantial variability following the exclusion of each study. This suggests that none of the studies had a significant impact on the OS results (Fig. 4A), while the stability of the PFS outcomes remains uncertain (Fig. 4B). Ultimately, the robustness of the findings from the OS analyses was confirmed.

Fig. 4
figure 4

Sensitivity analysis. (A): OS; (B): PFS

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Publication bias

To assess publication bias, we employed Egger’s regression test and funnel plots. For OS, the funnel plot revealed no discernible asymmetry (Fig. 5A), and the Egger test indicated no significant publication bias (P = 0.3). In contrast, for PFS, the funnel plot displayed notable asymmetry (Fig. 5B), suggesting potential publication bias.

Fig. 5
figure 5

Funnel plot for the evaluation of publication bias. (A): OS; (B): PFS

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Discussion

Currently, UC treatment primarily relies on conventional chemotherapeutic agents, with cisplatin as a cornerstone. However, recent advancements in immunotherapy have introduced emerging ICIs for UC that show promising outcomes [24]. Notably, atezolizumab has gained attention as a novel therapeutic option. Extensive research has assessed its efficacy in treating UC [25]. For example, studies by Galsky [26] and Sotelo [27] indicated that atezolizumab achieved prolonged disease control in some patients with mUC compared to standard agents like gemcitabine, cisplatin, and carboplatin. Additionally, atezolizumab demonstrates enhanced efficacy when combined with conventional chemotherapy regimens in UC.

We conducted a meta-analysis of clinical studies evaluating atezolizumab for treating UC, involving 4,148 individuals to evaluate its predictive accuracy. Our findings indicate that atezolizumab significantly improved OS and PFS in UC patients. Sensitivity analyses showed consistent OS measurements, and Egger’s test confirmed no publication bias, enhancing the confidence in our conclusions. Subgroup analyses revealed that both monotherapy and combination therapy prolonged patient survival, with combination therapy being more effective. Notably, there were significant ethnic disparities; European patients showed greater sensitivity compared to Asian and American patients. However, the effectiveness in these populations remains uncertain due to limited trials focusing on them. Future research is essential to assess the efficacy of atezolizumab in Asian and American populations more comprehensively.

A number of meta-analyses have shown the positive predictive potential of atezolizumab in specific cancer patient groups. Liu et al. [28] found that combining atezolizumab with bevacizumab significantly improved OS and PFS in 3,690 patients with hepatocellular carcinoma (HCC), compared to lenvatinib. Additionally, adverse events were less frequent in patients receiving the atezolizumab-bevacizumab combination than those treated with lenvatinib alone. Thus, this combination offers superior efficacy and a better safety profile for HCC treatment. Furthermore, Fu et al. [29] conducted a meta-analysis involving 6,348 lung cancer patients and reported that OS was significantly longer in the atezolizumab group compared to the docetaxel group, which also had lower treatment-related adverse events. Our meta-analysis pooled data from 4,148 patients and confirmed the significant prognostic value of atezolizumab in UC, consistent with other studies highlighting its predictive importance across various tumor types.

In addition, regarding the safety and efficacy of atezolizumab in treating UC, studies have shown that adverse reactions are predominantly immune-related events. Common mild side effects include fatigue, decreased appetite, and nausea [30]. The incidence of grade 3–4 adverse reactions is approximately 15%, with a lower occurrence of severe adverse events such as colitis and hypertension in patients with complex comorbidities. While generally well-tolerated, some immune-related adverse reactions, including pneumonia, hepatitis, and endocrine disorders, have been observed [31].

Recently, the immunological microenvironment has been recognized as a key factor in tumor persistence and treatment resistance [32]. Immunological checkpoint proteins in tumor cells significantly influence prognosis throughout their clinicopathological progression [33]. Atezolizumab inhibits tumor growth by modulating the transcription of circulating immune cells, enhancing antigen presentation and T-cell stimulation, activating dendritic cells, and promoting the elimination of antigen-specific T cells. Compared to conventional chemotherapeutic agents like gemcitabine, cisplatin, and carboplatin, atezolizumab reduces adverse effects by blocking the interaction between PD-L1 on tumor cells and PD-1 on T cells. This significantly lowers systemic toxicity associated with traditional chemotherapy [34, 35].

Atezolizumab has shown great potential for the treatment of UC in a variety of clinical Settings, from late second-line therapy to neoadjuvant therapy. Its efficacy is closely related to the level of PD-L1 expression, and its safety is generally considered manageable. Long-term follow-up data are critical to assess the ongoing treatment effect and to understand the mechanisms of immunotherapy resistance. The mechanism of drug resistance has been studied mainly involving tumor cells, immune microenvironment and host itself. One of the important reasons is that the epigenetic state of exhausted T cells is irreversible, and it is difficult to restore activity even if PD-1 is blocked, and tumor cells may also evade immune surveillance through other immune escape pathways. Therefore, further research on these phenomena is needed [34, 36]. Future studies should prioritize optimizing biomarker screening methods, such as integrating gene expression profiles or dynamically monitoring T cell status, and exploring combination therapies (such as in combination with chemotherapy or targeted drugs) to improve therapeutic efficacy.

Our article offers several significant advantages. Firstly, this meta-analysis represents the pioneering effort to evaluate the efficacy of atezolizumab in UC. Our findings provide robust evidence supporting the effectiveness of atezolizumab in extending OS and PFS among UC patients. Additionally, the studies included in our analysis are RCTs, which are characterized by a high level of evidence and credible results. Consequently, our study’s results offer substantial validation for the use of atezolizumab as a preferred therapeutic option for managing UC, thereby facilitating well-informed clinical decisions.

Despite the valuable insights provided by our meta-analysis, it is essential to acknowledge its limitations. Subgroup analyses revealed regional biases due to the limited number of relevant studies included. Specifically, there was an overrepresentation of European populations, while Asian, American and other regional groups were underrepresented. Therefore, we recommend that future studies adopt an international multicenter study design, particularly focusing on Asian and American populations, to further validate the safety profile of atezolizumab in the treatment of UC. Moreover, many studies did not provide clear information on blinding and allocation techniques, which may introduce potential biases. Given the ethnic and regional diversity observed in our findings, additional prospective studies are warranted to confirm the precise safety and efficacy of atezolizumab for UC. Other factors, such as disease stage, PD-L1 expression levels, and comorbidities, may also influence treatment efficacy. However, due to limited data availability, conducting subgroup analyses based on these parameters was not feasible, representing a limitation of our study.

Conclusion

In summary, this study demonstrates that the use of atezolizumab in combination with chemotherapeutic agents, or as a standalone treatment, can greatly extend the lifespan of patients with UC. It also shows superior efficacy compared to traditional chemotherapeutic agents alone. Subgroup analysis revealed that atezolizumab demonstrated greater efficacy in European patients compared to those from the Americas and Asia. These findings suggest that the use of atezolizumab, either in combination with chemotherapeutic agents or on its own, is a safe, effective, and comprehensive treatment approach for UC.

Data availability

The data used to support the findings of this study are included within the article.

Abbreviations

UC:

Urothelial carcinoma

PFS:

Progression-free survival

OS:

Overall survival

HR:

Hazard ratios

CI:

Confidence intervals

RCTs:

Randomized controlled trials

mUC:

Metastatic urothelial carcinoma

ICIs:

Immune checkpoint inhibitors

PD-L1:

Programmed cell death ligand-1

PD-1:

Programmed cell death-1

HCC:

Hepatocellular carcinoma

DFS:

Disease-free survival

RFS:

Recurrence-free survival

References

  1. Soares A, Bourlon MT, Wong A, et al. Management of metastatic urothelial carcinoma in emerging markets (EM): an expert opinion. Clin Genitourin Cancer. 2024;22(2):467–75.

    Article  PubMed  Google Scholar 

  2. Nahar R, Jinnah MSA, Karim SS, et al. Expression of Cyclin D1 in urothelial carcinoma of urinary bladder and its association with tumour grade. Mymensingh Med J. 2024;33(2):461–5.

    CAS  PubMed  Google Scholar 

  3. Hu H, Lai S, Ni R, et al. Efficacy of cytoreductive surgery for metastatic upper tract urothelial carcinoma: a surveillance, epidemiology and end results (SEER) study of 508 patients. Transl Androl Urol. 2024;13(6):983–93.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Zhang Y, Zheng J. Functions of immune checkpoint molecules beyond immune evasion. Adv Exp Med Biol. 2020;1248:201–26.

    Article  CAS  PubMed  Google Scholar 

  5. Darwish IA, Alahmad W, Vinoth R. Novel ultrasensitive automated kinetic exclusion assay for measurement of plasma levels of soluble PD-L1, the predictive and prognostic biomarker in cancer patients treated with immune checkpoint inhibitors. Heliyon. 2024;10(10):e31317.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Di Gianfrancesco L, Montagner IM, Tormen D, et al. The feasibility and diagnostic adequacy of PD-L1 expression analysis using the cytoinclusion technique in bladder cancer: A prospective Single-Center study. J Clin Med. 2024;13(14):4072.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Di Gianfrancesco L, Crestani A, Amodeo A, et al. The role of checkpoint inhibitor expression directly on exfoliated cells from bladder cancer: A narrative review. Diagnostics (Basel). 2023;13(19):3119.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Liu X, Lu Y, Qin S. Atezolizumab and bevacizumab for hepatocellular carcinoma: mechanism, pharmacokinetics and future treatment strategies. Future Oncol. 2021;17(17):2243–56.

    Article  CAS  PubMed  Google Scholar 

  9. Felip E, Altorki N, Zhou C, et al. Overall survival with adjuvant Atezolizumab after chemotherapy in resected stage II-IIIA non-small-cell lung cancer (IMpower010): a randomised, multicentre, open-label, phase III trial. Ann Oncol. 2023;34(10):907–19.

    Article  CAS  PubMed  Google Scholar 

  10. Qin S, Chen M, Cheng AL, et al. Atezolizumab plus bevacizumab versus active surveillance in patients with resected or ablated high-risk hepatocellular carcinoma (IMbrave050): a randomised, open-label, multicentre, phase 3 trial. Lancet. 2023;402(10415):1835–47.

    Article  CAS  PubMed  Google Scholar 

  11. Pal SK, Albiges L, Tomczak P, et al. Atezolizumab plus Cabozantinib versus Cabozantinib monotherapy for patients with renal cell carcinoma after progression with previous immune checkpoint inhibitor treatment (CONTACT-03): a multicentre, randomised, open-label, phase 3 trial. Lancet. 2023;402(10397):185–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Oaknin A, Gladieff L, Martínez-García J, et al. Atezolizumab plus bevacizumab and chemotherapy for metastatic, persistent, or recurrent cervical cancer (BEATcc): a randomised, open-label, phase 3 trial. Lancet. 2024;403(10421):31–43.

    Article  CAS  PubMed  Google Scholar 

  13. Lehmann BD, Abramson VG, Dees EC, et al. Atezolizumab in combination with carboplatin and survival outcomes in patients with metastatic Triple-Negative breast cancer: the TBCRC 043 phase 2 randomized clinical trial. JAMA Oncol. 2024;10(2):193–201.

    Article  PubMed  Google Scholar 

  14. Kurtz JE, Pujade-Lauraine E, Oaknin A, et al. Atezolizumab combined with bevacizumab and Platinum-Based therapy for Platinum-Sensitive ovarian cancer: Placebo-Controlled randomized phase III ATALANTE/ENGOT-ov29 trial. J Clin Oncol. 2023;41(30):4768–78.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. de Vries HM, Rafael TS, Gil-Jimenez A, et al. Atezolizumab with or without radiotherapy for advanced squamous cell carcinoma of the penis (The PERICLES Study): A Phase II Trial. J Clin Oncol. 2023;41(31):4872–80.

    Article  PubMed  Google Scholar 

  16. Hecht JR, Raman SS, Chan A, et al. Phase Ib study of talimogene Laherparepvec in combination with Atezolizumab in patients with triple negative breast cancer and colorectal cancer with liver metastases. ESMO Open. 2023;8(2):100884.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Ko AH, Kim KP, Siveke JT, et al. Atezolizumab plus PEGPH20 versus chemotherapy in advanced pancreatic ductal adenocarcinoma and gastric cancer: MORPHEUS phase Ib/II umbrella randomized study platform. Oncologist. 2023;28(6):553–e472.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lorenzen S, Götze TO, Thuss-Patience P, et al. Perioperative Atezolizumab plus fluorouracil, leucovorin, oxaliplatin, and docetaxel for resectable esophagogastric cancer: interim results from the randomized, multicenter, phase II/III DANTE/IKF-s633 trial. J Clin Oncol. 2024;42(4):410–20.

    Article  CAS  PubMed  Google Scholar 

  19. Younes A, Burke JM, Cheson BD, et al. Safety and efficacy of Atezolizumab with rituximab and CHOP in previously untreated diffuse large B-cell lymphoma. Blood Adv. 2023;7(8):1488–95.

    Article  CAS  PubMed  Google Scholar 

  20. Bamias A, Davis ID, Galsky MD, et al. Atezolizumab monotherapy versus chemotherapy in untreated locally advanced or metastatic urothelial carcinoma (IMvigor130): final overall survival analysis from a randomised, controlled, phase 3 study. Lancet Oncol. 2024;25(1):46–61.

    Article  CAS  PubMed  Google Scholar 

  21. Grande E, Arranz JÁ, De Santis M, et al. Atezolizumab plus chemotherapy versus placebo plus chemotherapy in untreated locally advanced or metastatic urothelial carcinoma (IMvigor130): final overall survival analysis results from a randomised, controlled, phase 3 study. Lancet Oncol. 2024;25(1):29–45.

    Article  CAS  PubMed  Google Scholar 

  22. Qian D, Xu Y, Wu Y, et al. Assessment of the safety and efficacy of combination chemotherapy and PD-1/PD-L1 inhibitor treatment of breast cancer: A meta-analysis. Chin Med J (Engl). 2023;136(14):1663–70.

    CAS  PubMed  Google Scholar 

  23. Lu Y, Zhang X, Ning J, et al. Immune checkpoint inhibitors as first-line therapy for non-small cell lung cancer: A systematic evaluation and meta-analysis. Hum Vaccin Immunother. 2023;19(1):2169531.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Rouprêt M, Seisen T, Birtle AJ, et al. European association of urology guidelines on upper urinary tract urothelial carcinoma: 2023 update. Eur Urol. 2023;84(1):49–64.

    Article  PubMed  Google Scholar 

  25. Piombino C, Tonni E, Oltrecolli M, et al. Immunotherapy in urothelial cancer: current status and future directions. Expert Rev Anticancer Ther. 2023;23(11):1141–55.

    Article  CAS  PubMed  Google Scholar 

  26. Galsky MD, Guan X, Rishipathak D, et al. Immunomodulatory effects and improved outcomes with cisplatin- versus carboplatin-based chemotherapy plus Atezolizumab in urothelial cancer. Cell Rep Med. 2024;5(2):101393.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Sotelo M, Muñoz-Unceta N, Matorras A, et al. Outcomes with Atezolizumab in metastatic urothelial cancer: real-world data from a single institution. Clin Transl Oncol. 2024;26(3):682–8.

    Article  CAS  PubMed  Google Scholar 

  28. Liu J, Yang L, Wei S, et al. Efficacy and safety of Atezolizumab plus bevacizumab versus lenvatinib for unresectable hepatocellular carcinoma: a systematic review and meta-analysis. J Cancer Res Clin Oncol. 2023;149(17):16191–201.

    Article  CAS  PubMed  Google Scholar 

  29. Fu Y, Xue G. Meta-Analysis of Atezolizumab vs docetaxel in Non-Small cell lung cancer treatment outcomes. Altern Ther Health Med. 2023;29(6):128–33.

    PubMed  Google Scholar 

  30. Rosenberg JE, Galsky MD, Powles T, et al. Atezolizumab monotherapy for metastatic urothelial carcinoma: final analysis from the phase II IMvigor210 trial. ESMO Open. 2024;9(12):103972.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Mavadia A, Choi S, Ismail A, et al. An overview of immune checkpoint inhibitor toxicities in bladder cancer. Toxicol Rep. 2024;13:101732.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Xu Y, Miller CP, Tykodi SS, et al. Signaling crosstalk between tumor endothelial cells and immune cells in the microenvironment of solid tumors. Front Cell Dev Biol. 2024;12:1387198.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Morita M, Nishida N, Aoki T, et al. Role of β-Catenin activation in the tumor immune microenvironment and immunotherapy of hepatocellular carcinoma. Cancers (Basel). 2023;15(8):2311.

    Article  CAS  PubMed  Google Scholar 

  34. Bosnali E, Akdas EM, Telli E, et al. The role of immunotherapy in urological cancers. Arch Ital Urol Androl. 2024;96(2):12307.

    PubMed  Google Scholar 

  35. Evans ST, Jani Y, Jansen CS, et al. Understanding and overcoming resistance to immunotherapy in genitourinary cancers. Cancer Biol Ther. 2024;25(1):2342599.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Alqarni KA. Recent advances in immunotherapy for bladder cancer treatment. Cureus. 2025;17(2):e79002.

    PubMed  PubMed Central  Google Scholar 

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Acknowledgements

Not applicable.

Funding

The study did not receive any specific funding from funding agencies in the public, commercial or non-profit sectors.

Author information

Author notes

  1. Jun Xie and Qiu-yu Mao contributed equally to this work.

Authors and Affiliations

  1. Urology Department of the Second Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650101, China

    Jun Xie, Qiu-yu Mao, Jun-hao Chen, Hong-jin Shi, Pei-qin Zhan & Hai-feng Wang

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  5. Pei-qin Zhan
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  6. Hai-feng Wang
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Contributions

All authors contributed to the study conception and design. JX and QYM: Conceptualization, Methodology, Software, Writing- Original draft, Data curation, Visualization were performed; JHC, HJS and PQZ: Investigation, Writing - Original Draft, Writing - Reviewing and Editing were performed; HFW: Conceptualization, Supervisio were performed. All authors read and approved the final manuscript.

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Correspondence to Hai-feng Wang.

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Xie, J., Mao, Qy., Chen, Jh. et al. Efficacy and safety of atezolizumab in the treatment of urothelial carcinoma: a systematic review and meta-analysis. World J Surg Onc 23, 133 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12957-025-03795-1

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12957-025-03795-1

Keywords

World Journal of Surgical Oncology

ISSN: 1477-7819

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