Maráz Anikó, Varga Linda, Pósfai Boglárka, Géczi Lajos, Küronya Zsófia
Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
Magy Onkol. 2021 Dec 7;65(4):329-337. Epub 2021 Oct 20.
Chemotherapy for the treatment of urothelial and bladder cancers has focused on renewed indications in light of clinical trials of modern therapies, which are described in our review. In stage T2-T4a N0-1 M0 cases, that are suitable for cisplatin, surgery is performed after neoadjuvant cisplatin- based chemotherapy. Less significant result is observed with adjuvant chemotherapy, especially in pT3-4 and/or N+ stage, if no neoadjuvant chemotherapy was administered. Cisplatin-based chemotherapy is the first-line treatment of cisplatin-eligible metastatic patients. First-line choice in chemo-fit cases with cisplatin ineligibility can be carboplatin- based chemotherapy. 4-6 cycles of cisplatin or carboplatin cause stable disease or regression, maintenance avelumab immunotherapy improves patient's survival. For those patients who progress during or after platinum-based chemotherapy, the effectiveness of chemotherapy in the second/multiple lines is less favourable in comparison with immunotherapy and targeted therapy. Modern antibody - cytotoxic drug conjugates have been discovered in the form of enfortumab vedotin and sacituzumab govitecan, and currently they seem to be effective in the third line after chemotherapy and immunotherapy.
鉴于现代疗法的临床试验情况,尿路上皮癌和膀胱癌的化疗重点在于新的适应症,这些内容在我们的综述中有描述。在适合顺铂治疗的T2 - T4a N0 - 1 M0期病例中,新辅助顺铂化疗后进行手术。如果未进行新辅助化疗,辅助化疗的效果不太显著,尤其是在pT3 - 4和/或N + 期。基于顺铂的化疗是适合顺铂的转移性患者的一线治疗方法。对于不适合顺铂的化疗适宜病例,一线选择可以是基于卡铂的化疗。4 - 6周期的顺铂或卡铂可导致病情稳定或缓解,avelumab维持免疫疗法可提高患者生存率。对于那些在铂类化疗期间或之后病情进展的患者,与免疫疗法和靶向疗法相比,二线/多线化疗的效果较差。已发现现代抗体 - 细胞毒性药物偶联物,如enfortumab vedotin和sacituzumab govitecan,目前它们在化疗和免疫疗法后的三线治疗中似乎有效。