The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Curr Opin Oncol. 2019 May;31(3):183-187. doi: 10.1097/CCO.0000000000000533.
There is a significant unmet need for efficacious second-line treatment options for patients who have failed bacillus Calmette-Guerin (BCG) therapy for nonmuscle invasive urothelial carcinoma (NMIBC). Recent advances in our understanding of systemic immunotherapy have transformed the management of advanced urothelial carcinoma and have led to the development of multiple novel agents. Using this insight, these agents are now being investigated for use in NMIBC.
Although BCG has been used to treat high-risk NMIBC for decades, new applications of immunotherapy include the use of exogenous cytokines to boost immune response, vaccines to activate the immune system against specific tumor-associated antigens, intravesical agents that cause generalized local inflammation, and targeted antibodies against proteins on the surface of immune checkpoint inhibitors. Although most of these agents are still being investigated in clinical trials and are not yet considered standard of care, they hold significant promise in the treatment of patients with high-risk NMIBC.
The use of immunotherapy has significantly improved survival outcomes in advanced urothelial carcinoma. Based on rapid advances in our understanding of the immune system and tumor biology, these agents are also poised to alter the therapeutic landscape for NMIBC dramatically as clinical trials are completed.
对于卡介苗（BCG）治疗失败的非肌肉浸润性膀胱癌（NMIBC）患者，存在着对有效二线治疗选择的巨大未满足需求。我们对系统性免疫疗法的理解的最新进展改变了晚期膀胱癌的治疗管理，并导致了多种新型药物的开发。利用这一认识，目前正在研究这些药物在 NMIBC 中的应用。
尽管 BCG 已被用于治疗高危 NMIBC 数十年，但免疫疗法的新应用包括使用外源性细胞因子来增强免疫反应、使用疫苗来激活针对特定肿瘤相关抗原的免疫系统、引起全身性局部炎症的膀胱内药物以及针对免疫检查点抑制剂表面蛋白的靶向抗体。尽管这些药物中的大多数仍在临床试验中进行研究，尚未被视为标准治疗方法，但它们在治疗高危 NMIBC 患者方面具有很大的潜力。
免疫疗法的应用显著改善了晚期膀胱癌患者的生存结果。基于我们对免疫系统和肿瘤生物学的理解的快速进展，随着临床试验的完成，这些药物也有望极大地改变 NMIBC 的治疗格局。
