Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy.
Curr Opin Support Palliat Care. 2012 Sep;6(3):304-9. doi: 10.1097/SPC.0b013e3283552d19.
Although bladder cancer is considered a chemosensitive disease, the prognosis of patients with metastatic disease is still poor with median survival being approximately 12-14 months in good prognosis patients and with cure in only a minority of patients. The addition of new drugs to the standard cisplatin-based regimens has not improved these figures. The purpose of this review is to highlight the role of chemotherapy and the impact of the new targeted agents in the treatment of metastatic bladder carcinoma.
A better understanding of the biology of the molecular patterns of urothelial bladder cancer has led to the clinical investigation of several therapeutic targets such as antiangiogenics, anti-EGFR agents, and immunomodulatory agents. To date, these agents have yet to demonstrate an improvement in overall survival. The molecular alterations that drive platinum resistance and the study of the genetic profiles will help to identify the prognostic and predictive biomarkers.
No major advances have been achieved in the recent years in the treatment of urothelial carcinoma of the bladder. Chemotherapy remains the mainstay of treatment of metastatic disease. Several targeted agents are currently under investigation, but no major breakthroughs have been achieved with these drugs. Development of less toxic, more effective agents is crucial and clinical trial participation needs to be emphasized.
尽管膀胱癌被认为是一种化疗敏感的疾病,但转移性疾病患者的预后仍然较差,预后良好的患者的中位生存期约为 12-14 个月,只有少数患者能够治愈。在标准顺铂为基础的方案中添加新药并没有改善这些数据。本文的目的是强调化疗在转移性膀胱癌治疗中的作用,以及新的靶向药物的影响。
对尿路上皮膀胱癌分子模式的生物学的更好理解,导致了对几种治疗靶点的临床研究,如抗血管生成剂、抗 EGFR 药物和免疫调节剂。迄今为止,这些药物尚未显示出总生存期的改善。推动铂耐药的分子改变和遗传谱的研究将有助于确定预后和预测生物标志物。
近年来,在治疗膀胱癌方面没有取得重大进展。化疗仍然是转移性疾病治疗的主要手段。目前正在研究几种靶向药物,但这些药物尚未取得重大突破。开发毒性更小、更有效的药物至关重要,需要强调临床试验的参与。