Roviello Giandomenico, Catalano Martina, Santi Raffaella, Santoni Matteo, Galli Ilaria Camilla, Amorosi Andrea, Polom Wojciech, De Giorgi Ugo, Nesi Gabriella
Department of Health Sciences, University of Florence, Florence, Italy.
School of Human Health Sciences, University of Florence, Florence, Italy.
Front Oncol. 2022 Jul 22;12:912699. doi: 10.3389/fonc.2022.912699. eCollection 2022.
Urothelial carcinoma of the bladder is one of the most prevalent cancers worldwide, diagnosed as muscle invasive in 25% of cases. Although several studies have demonstrated an overall 5% absolute survival benefit at 5 years with cisplatin-based combination neoadjuvant treatment, administration of chemotherapy prior to radical cystectomy (RC) in muscle-invasive bladder cancer (MIBC) patients is still a matter of debate. This may be due to the perceived modest survival benefit, cisplatin-based chemotherapy ineligibility, or fear of delaying potentially curative surgery in non-responders. However, immunotherapy and novel targeted therapies have shown to prolong survival in advanced disease and are under investigation in the neoadjuvant and adjuvant settings to reduce systemic relapse and improve cure rates. Genomic characterization of MIBC could help select the most effective chemotherapeutic regimen for the individual patient. Large cohort studies on neoadjuvant treatments with immune checkpoint inhibitors (ICIs) and molecular therapies, alone or combined with chemotherapy, are ongoing. In this review, we trace the development of neoadjuvant therapy in MIBC and explore recent advances that may soon change clinical practice.
膀胱尿路上皮癌是全球最常见的癌症之一，25%的病例被诊断为肌层浸润性癌。尽管多项研究表明，基于顺铂的联合新辅助治疗在5年时总体绝对生存获益为5%，但对于肌层浸润性膀胱癌（MIBC）患者，在根治性膀胱切除术（RC）前给予化疗仍存在争议。这可能是由于生存获益不明显、不符合基于顺铂的化疗条件，或担心在无反应者中延迟可能治愈性手术。然而，免疫疗法和新型靶向疗法已显示可延长晚期疾病患者的生存期，目前正在新辅助和辅助治疗中进行研究，以减少全身复发并提高治愈率。MIBC的基因组特征有助于为个体患者选择最有效的化疗方案。关于免疫检查点抑制剂（ICI）和分子疗法单独或联合化疗进行新辅助治疗的大型队列研究正在进行。在本综述中，我们追溯了MIBC新辅助治疗的发展历程，并探讨了可能很快改变临床实践的最新进展。
