Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive Room 12N226, Bethesda, MD, 20892, USA.
Curr Treat Options Oncol. 2018 May 28;19(7):36. doi: 10.1007/s11864-018-0551-z.
Muscle-invasive bladder cancer (MIBC) has high metastatic potential at diagnosis but is still often curable with aggressive management, which may give patients the best odds for a favorable clinical outcome. The standard-of-care management of MIBC includes a radical cystectomy and pelvic lymph node dissection. If the patient is cisplatin-eligible, neoadjuvant cisplatin-based combination chemotherapy should also be given. Post-surgery adjuvant treatments include observation, chemotherapy, radiation, or enrollment in a clinical trial. Several adjuvant immunotherapy trials with checkpoint inhibitors, which block the interaction between PD-1 and PD-L1, as monotherapy or in combinations with chemotherapy, radiation, or other immunotherapy agents are currently ongoing. Given the lack of level 1 evidence for the survival benefit of adjuvant therapies post-cystectomy, the standard of care remains observation with radiologic and clinical surveillance. However, in patients who did not receive neoadjuvant cisplatin-based combination chemotherapy and are cisplatin-eligible, adjuvant cisplatin-based chemotherapy should be considered and discussed. Genomic alterations and gene expression profiles may eventually help to identify patient subgroups for more effective adjuvant therapy. Genetic abnormalities in the DNA repair genes and basal intrinsic tumor subtype appear to predict response to neoadjuvant cisplatin-based chemotherapy in MIBC. In the coming years, validating these genetic markers will be key to individualizing perioperative chemotherapy.
肌层浸润性膀胱癌（MIBC）在诊断时具有较高的转移潜能，但通过积极的治疗管理，仍常常可以治愈，这可能为患者带来有利的临床结局。MIBC 的标准治疗管理包括根治性膀胱切除术和盆腔淋巴结清扫术。如果患者适合使用顺铂，也应给予新辅助顺铂为基础的联合化疗。术后辅助治疗包括观察、化疗、放疗或参加临床试验。目前正在进行几项联合检查点抑制剂的辅助免疫治疗试验，这些抑制剂可阻断 PD-1 和 PD-L1 之间的相互作用，作为单药治疗或与化疗、放疗或其他免疫治疗药物联合使用。鉴于术后辅助治疗对生存获益缺乏 1 级证据，标准治疗仍然是观察性的，包括影像学和临床监测。然而，对于未接受新辅助顺铂为基础的联合化疗且适合顺铂治疗的患者，应考虑并讨论辅助顺铂为基础的化疗。基因组改变和基因表达谱最终可能有助于确定更有效的辅助治疗患者亚组。在 MIBC 中，DNA 修复基因和基底固有肿瘤亚型中的遗传异常似乎可预测对新辅助顺铂为基础化疗的反应。在未来几年，验证这些遗传标志物将是实现围手术期化疗个体化的关键。
