[Immunotherapy for urological cancers in 2025].

AIM: To review the development of immunotherapy (IO) for urological cancers (urothelial carcinoma - UC, renal cell carcinoma - RCC, prostate cancer - PCa , testicular germ cell tumors - TGCT) with a focus on the latest studies, combination strategies, and the messages of the 2025 guidelines.

METHODS

Review of randomized phase II-III studies published in 2024-2025, international guidelines, and biomarker- guided approaches.

RESULTS

In UC, the combination of enfortumab vedotin and pembrolizumab has been a breakthrough and has become the new first-line standard, while maintenance and adjuvant immunotherapies have also been strengthened. In RCC, IO- TKI and IO-IO combinations show long-term survival benefits, but the IO-after-IO strategy has proven questionable. In PCa, the efficacy of immunotherapy is mainly limited to biomarker-driven subgroups (MSI-H/dMMR), while in TGCT, cisplatin-based treatment remains the standard, and the role of IOs is being evaluated in further studies.

CONCLUSIONS

By 2025, immunotherapy has become the therapeutic basis for UC and RCC, both in metastatic and curative treatments. In PCa and TGCT, immunotherapy options remain in the experimental phase, but research is ongoing with new combinations and biomarker-driven strategies.