University of Foggia, Bonomo Teaching Hospital, UO of Urology, Andria, Italy.
University of Chieti, Urology, Italy.
Curr Drug Targets. 2021;22(1):14-21. doi: 10.2174/1389450121666200802022150.
This study provides a critical literature review on state-of-the-art and novel strategies in the field of neoadjuvant treatments for muscle-invasive bladder cancer (MIBC).
A nonsystematic literature review was performed using PubMed, Scopus and Clinical Trials.gov to retrieve papers related to neoadjuvant treatments for MIBC over the past 15 years. Prospective and retrospective studies were included.
Platinum-based treatment is the gold standard and mainly consists of a combination of cisplatin with vinblastine, methotrexate, doxorubicin, gemcitabine, adriamycin or even epirubicin. The 5- year absolute overall survival benefit of MVAC is 5% and the absolute disease-free survival improves by 9%. CMV treatment is associated with a 10-year overall survival improving from 30% to 36% and a 16% reduction in mortality. Gemcitabine and cisplatin regimen provides complete response in 20% of cases, with non-inferior oncological outcomes compared to MVAC regimen. Recent prospective trials investigating neoadjuvant immunotherapy show a high rate of complete response, from 29% with atezolizumab to 39.5% with pembrolizumab. The tyrosine kinase inhibitor pathway is being explored and could offer an interesting strategy to improve survival outcomes.
Available evidence suggests better oncological outcomes for MIBC patients receiving neoadjuvant treatment before radical cystectomy. While MVAC remains the standard of care in cisplatin eligible patients, novel strategies are under development for cisplatin-ineligible patients, whereby immunotherapy seems to hold great promise.
本研究对肌层浸润性膀胱癌（MIBC）新辅助治疗领域的最新技术和新策略进行了文献综述。
使用 PubMed、Scopus 和 ClinicalTrials.gov 进行非系统性文献回顾，检索过去 15 年来有关 MIBC 新辅助治疗的论文。纳入前瞻性和回顾性研究。
铂类药物治疗是金标准，主要包括顺铂联合长春碱、甲氨蝶呤、多柔比星、吉西他滨、阿霉素甚至表柔比星。MVAC 的 5 年绝对总生存率获益为 5%，无病生存率绝对提高 9%。CMV 治疗与 10 年总生存率提高 36%相关，死亡率降低 16%。吉西他滨和顺铂方案使 20%的病例达到完全缓解，与 MVAC 方案相比，其肿瘤学结局非劣效。最近的新辅助免疫治疗前瞻性试验显示，完全缓解率较高，阿替利珠单抗为 29%，帕博利珠单抗为 39.5%。酪氨酸激酶抑制剂途径正在探索中，可能为改善生存结果提供一种有前景的策略。
现有证据表明，接受根治性膀胱切除术前新辅助治疗的 MIBC 患者具有更好的肿瘤学结局。虽然 MVAC 在顺铂适用患者中仍是标准治疗方法，但正在为顺铂不适用患者开发新的策略，免疫疗法似乎具有很大的前景。
