Pectasides D, Pectasides M, Economopoulos Th
Second Department of Internal Medicine, Propaedeutic, Oncology Section, Attikon University Hospital, Rimini 1, Haidari, 15342 Athens, Greece.
Cancer Treat Rev. 2006 Oct;32(6):456-70. doi: 10.1016/j.ctrv.2006.07.004. Epub 2006 Aug 28.
Transitional cell carcinoma of the bladder is a common malignancy. Advanced urothelial cancer is a chemosenstive neoplasm. Whereas the MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) regimen was long-considered the standard of care for patients with advanced disease, the evaluation of newer agents with retained activity and improved tolerability has been the focus of much investigation over the past decade. Combinations such as cisplatin-gemcitabine (GC) and intensified, G-CSF supported MVAC have shown more favourable toxicity profile and equal or even improved efficacy. Specific groups of patients (elderly, patients with renal dysfunction or poor performance status or co-morbidities) who cannot tolerate cisplatin-based therapy, should receive carboplatin, gemcitabine or taxane-based treatment. Continuing improvements in our understanding of the molecular phenotype of individual patient tumors may lead to the appropriate therapies that target molecular aberrations unique to this malignancy. This review will summarize recent developments in the management of locally advanced (T4b, N 2-3) and/or metastatic (M1) bladder cancer.
膀胱移行细胞癌是一种常见的恶性肿瘤。晚期尿路上皮癌是一种对化疗敏感的肿瘤。虽然长期以来，MVAC（甲氨蝶呤、长春花碱、阿霉素和顺铂）方案一直被视为晚期疾病患者的标准治疗方案，但在过去十年中，对具有保留活性和更好耐受性的新型药物的评估一直是大量研究的重点。顺铂-吉西他滨（GC）等联合方案以及强化的、有粒细胞集落刺激因子（G-CSF）支持的MVAC方案已显示出更有利的毒性特征和同等甚至更好的疗效。无法耐受基于顺铂治疗的特定患者群体（老年人、肾功能不全患者、体能状态差或有合并症的患者）应接受基于卡铂、吉西他滨或紫杉烷的治疗。我们对个体患者肿瘤分子表型的理解不断进步，这可能会带来针对这种恶性肿瘤独特分子异常的合适治疗方法。本综述将总结局部晚期（T4b，N 2-3）和/或转移性（M1）膀胱癌治疗的最新进展。
