Department of Urology, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
Expert Opin Pharmacother. 2010 Apr;11(6):947-58. doi: 10.1517/14656561003657145.
Although transurethral resection of bladder tumor (TURBT) is effective therapy, up to 45% of patients will have a recurrence within 1 year after TURBT alone. Further, there is a 3 - 15% risk of tumor progression to muscle invasive and/or metastatic cancer. Depending on patient and tumor characteristics, a number of patients may benefit from some form of intravesical therapy. Adjuvant therapy is effective in avoiding post-TURBT implantation of tumor cells, eradicating residual disease, preventing tumor recurrence, and to delay or reduce tumor progression through direct cytoablation or immunostimulation.
The role of risk assessment in the management of nonmuscle invasive bladder cancer (NMIBC) and the indications for the use of intravesical agents are discussed. Findings from major randomized clinical trials on BCG, interferon and various chemotherapeutic agents are summarized; key aspects of drug pharmacology, drug efficacy, side effects, and toxicity are also covered.
The reader will gain a basic understanding of the role of risk assessment in determining the need for intravesical therapy, as well as an overview of the different types of agents in use in the United States today.
The type of intravesical therapy used is based on the risk groups as noted in the European prognostic tables. Bacillus Calmette-Guerin (BCG) is the most commonly used first-line agent immunotherapeutic agent for prophylaxis and treatment of carcinoma in situ and high-grade bladder cancer. Other immunotherapeutic options include the interferons, interleukins 2 and 12, and tumor necrosis factor, all of which have activity in BCG refractory patients, although with low durable remission rates. Studies have shown that chemotherapy prevents recurrence but not progression. The available data on intravesical chemotherapy do not indicate that any single agent currently in use is clearly better than any other. Therefore, the selection of a chemotherapeutic agent is usually based on cost, toxicity, and availability as well as on physician preference and experience.
虽然经尿道膀胱肿瘤切除术（TURBT）是有效的治疗方法，但高达 45%的患者在单独接受 TURBT 后 1 年内会复发。此外，肿瘤进展为肌层浸润和/或转移性癌症的风险为 3-15%。根据患者和肿瘤的特点，许多患者可能受益于某种形式的膀胱内治疗。辅助治疗可有效避免 TURBT 后肿瘤细胞种植、消除残留疾病、预防肿瘤复发，并通过直接细胞消融或免疫刺激来延迟或减少肿瘤进展。
讨论了风险评估在非肌肉浸润性膀胱癌（NMIBC）管理中的作用以及膀胱内药物使用的适应证。总结了主要随机临床试验中关于卡介苗、干扰素和各种化疗药物的发现；还涵盖了药物药理学、药物疗效、副作用和毒性的关键方面。
读者将基本了解风险评估在确定膀胱内治疗需求中的作用，以及当今美国使用的不同类型药物的概述。
所使用的膀胱内治疗类型基于欧洲预后表中指出的风险组。卡介苗（BCG）是最常用的一线免疫治疗药物，用于预防和治疗原位癌和高级别膀胱癌。其他免疫治疗选择包括干扰素、白细胞介素 2 和 12 以及肿瘤坏死因子，所有这些在 BCG 耐药患者中都具有活性，但持久缓解率低。研究表明，化疗可预防复发，但不能预防进展。目前关于膀胱内化疗的可用数据并未表明目前使用的任何单一药物明显优于其他药物。因此，化疗药物的选择通常基于成本、毒性和可及性，以及医生的偏好和经验。
