Apolo Andrea B, Vogelzang Nicholas J, Theodorescu Dan
From the Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute at the National Institutes of Health, Bethesda, MD; US Oncology Research, Houston, TX and Comprehensive Cancer Centers of Nevada, Las Vegas, NV; University of Colorado Cancer Center, Denver, CO.
Am Soc Clin Oncol Educ Book. 2015:105-12. doi: 10.14694/EdBook_AM.2015.35.105.
Bladder cancer is a complex and aggressive disease for which treatment strategies have had limited success. Improvements in detection, treatment, and outcomes in bladder cancer will require the integration of multiple new approaches, including genomic profiling, immunotherapeutics, and large randomized clinical trials. New and promising strategies are being tested in all disease states, including nonmuscle-invasive bladder cancer (NMIBC), muscle-invasive bladder cancer (MIBC), and metastatic urothelial carcinoma (UC). Efforts are underway to develop better noninvasive urine biomarkers for use in primary or secondary detection of NMIBC, exploiting our genomic knowledge of mutations in genes such as RAS, FGFR3, PIK3CA, and TP53 and methylation pathways alone or in combination. Recent data from a large, randomized phase III trial of adjuvant cisplatin-based chemotherapy add to our knowledge of the value of perioperative chemotherapy in patients with MIBC. Finally, bladder cancer is one of a growing list of tumor types that respond to immune checkpoint inhibition, opening the potential for new therapeutic strategies for treatment of this complex and aggressive disease.
膀胱癌是一种复杂且侵袭性强的疾病，其治疗策略成效有限。膀胱癌在检测、治疗和预后方面的改善需要整合多种新方法，包括基因组分析、免疫疗法以及大型随机临床试验。针对包括非肌层浸润性膀胱癌（NMIBC）、肌层浸润性膀胱癌（MIBC）和转移性尿路上皮癌（UC）在内的所有疾病状态，新的且有前景的策略正在进行测试。正在努力开发更好的非侵入性尿液生物标志物，用于NMIBC的一级或二级检测，单独或联合利用我们对RAS、FGFR3、PIK3CA和TP53等基因突变以及甲基化途径的基因组知识。一项基于顺铂的辅助化疗大型随机III期试验的最新数据增加了我们对MIBC患者围手术期化疗价值的认识。最后，膀胱癌是对免疫检查点抑制有反应的肿瘤类型之一，这为治疗这种复杂且侵袭性强的疾病开辟了新治疗策略的潜力。
