Gómez De Liaño Alfonso, Duran Ignacio
Medical Oncology Department, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain.
Servicio de Oncologia Medica, Medical Oncology Department, Hospital Universitario Marques de Valdecilla, Edificio Sur, 2 Planta, Despacho 277, 39008 Santander, Spain.
Ther Adv Urol. 2018 Nov 28;10(12):455-480. doi: 10.1177/1756287218814100. eCollection 2018 Dec.
Despite intense drug development in the last decade in metastatic urothelial carcinoma and the incorporation of novel compounds to the treatment armamentarium, chemotherapy remains a key treatment strategy for this disease. Platinum-based combinations are still the backbone of first-line therapy in most cases. The role of chemotherapy in the second line has been more ill-defined due to the complexity of this setting, where patient selection remains critical. Nevertheless, two regimens, one in monotherapy (i.e. vinflunine) and one in combination with antiangiogenics (i.e. docetaxel + ramucirumab) have shown efficacy. Immunotherapy through checkpoint inhibition has revealed remarkably durable benefit in a small proportion of patients in the first and second line and is currently the preferred partner for combinations with chemotherapy. Difficult populations such as patients with liver metastases or those progressing to checkpoint inhibition represent a medical challenge and selective ways of delivering cytotoxics, like the antibody-drug conjugates, might represent a valid alternative. This article reviews the current role of chemotherapy in the management of advanced urothelial carcinoma and the ongoing and coming studies involving this treatment strategy.
尽管在过去十年中转移性尿路上皮癌的药物研发工作十分密集，且新型化合物已被纳入治疗手段，但化疗仍然是该疾病的关键治疗策略。在大多数情况下，铂类联合方案仍是一线治疗的基础。由于二线治疗情况复杂，患者选择仍然至关重要，化疗在二线治疗中的作用一直不太明确。然而，两种方案已显示出疗效，一种是单药治疗（即长春氟宁），另一种是与抗血管生成药物联合使用（即多西他赛+雷莫西尤单抗）。通过检查点抑制进行的免疫治疗在一小部分一线和二线患者中显示出显著持久的益处，目前是与化疗联合使用的首选方案。像肝转移患者或对检查点抑制治疗进展的患者等困难群体是医学上的挑战，而递送细胞毒性药物的选择性方法，如抗体药物偶联物，可能是一种有效的替代方案。本文综述了化疗在晚期尿路上皮癌管理中的当前作用以及涉及该治疗策略的正在进行和即将开展的研究。
