Mukherjee Neelam, Svatek Robert S, Mansour Ahmed M
Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
Urol Oncol. 2018 Mar;36(3):103-108. doi: 10.1016/j.urolonc.2017.12.020. Epub 2018 Feb 9.
Intravesical instillation of live attenuated bacillus Calmette-Guérin (BCG) is the gold standard for patients with intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC). BCG-failures include a heterogenous population of patients who share a designation of disease recurrence or progression following BCG and include patients with complete unresponsiveness to BCG, patients who respond initially but develop relapse and, in some cases, patients who are intolerant to BCG due to side effects. Given the efficacy and relatively rapid approval of several monoclonal antibodies against PD-L1 or PD-1 for advanced and metastatic bladder cancer, the role of these checkpoint inhibitors in BCG-relapsing disease at various disease stages is under consideration. Data supporting a role for immune checkpoint inhibitors is largely theoretical with limited supportive data from animal models and from clinical evidence of increased PD-L1 expression in BCG-unresponsive tumors. Current trials in BCG-unresponsive disease are underway and expected to provide insight regarding these concepts.
膀胱内灌注减毒活卡介苗（BCG）是中高危非肌层浸润性膀胱癌（NMIBC）患者的金标准。卡介苗治疗失败包括一组异质性患者，这些患者在卡介苗治疗后出现疾病复发或进展，包括对卡介苗完全无反应的患者、最初有反应但出现复发的患者，以及在某些情况下因副作用而不耐受卡介苗的患者。鉴于几种抗PD-L1或PD-1单克隆抗体对晚期和转移性膀胱癌具有疗效且获批相对迅速，这些检查点抑制剂在不同疾病阶段的卡介苗复发性疾病中的作用正在被考虑。支持免疫检查点抑制剂作用的数据在很大程度上是理论性的，来自动物模型的支持数据有限，且卡介苗无反应肿瘤中PD-L1表达增加的临床证据也有限。目前针对卡介苗无反应疾病的试验正在进行，预计将提供有关这些概念的见解。
