Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, Los Angeles, CA 90095, USA.
School of Medicine, National & Kapodistrian University of Athens, 15772 Athens, Greece.
Curr Oncol. 2023 Aug 4;30(8):7398-7411. doi: 10.3390/curroncol30080536.
Bladder cancer is one of the most commonly diagnosed genitourinary malignancies. For many years, the primary treatment for metastatic urothelial cancer (mUC) was predicated on the use of platinum-based chemotherapy. More recently, immune checkpoint inhibitors (ICIs) were approved by regulatory agencies such as the US FDA for use in both the first- and second-line settings. This review outlines the approved ICIs for mUC in the second-line setting and as an alternative to chemotherapy in the first-line setting, as well as the novel agents that have also been incorporated into the treatment of this malignancy. Single-agent ICIs are often used in second-line settings in mUC, and there are three drugs currently approved for those who progress after receiving platinum-based chemotherapy. In the first-line setting, the preferred treatment regimen remains cisplatin-based chemotherapy. However, single-agent ICI can be an alternative first-line treatment for those who are not candidates for cisplatin-based therapy. There are also clinical trials adding ICIs to chemotherapy as combination regimens. However, treatment for mUC has now expanded even beyond immunotherapy. Newer targeted agents such as erdafitinib, a fibroblast growth factor receptor inhibitor, and two antibody-drug conjugates, enfortumab vedotin and sacituzumab govitecan, have been recently approved. As new drug agents are discovered, it will be important to assess both the treatment outcomes as well as the effects on patients' quality of life. Furthermore, integrating genetic and molecular information can help guide treatment decisions as next-generation sequencing is more commonly acquired during the evaluation of newly diagnosed patients with advanced and metastatic cancer.
膀胱癌是最常见的泌尿系统恶性肿瘤之一。多年来，转移性尿路上皮癌（mUC）的主要治疗方法是基于使用铂类化疗。最近，免疫检查点抑制剂（ICI）被美国 FDA 等监管机构批准用于一线和二线治疗。这篇综述概述了二线治疗 mUC 时批准的 ICI 以及一线治疗时替代化疗的药物，以及也已纳入治疗这种恶性肿瘤的新型药物。单药 ICI 通常用于 mUC 的二线治疗，目前有三种药物在接受铂类化疗后进展的患者中获批。在一线治疗中，首选的治疗方案仍然是基于顺铂的化疗。然而，对于不适合顺铂治疗的患者，单药 ICI 可以作为替代一线治疗。也有临床试验将 ICI 与化疗联合作为联合治疗方案。然而，mUC 的治疗现在甚至已经扩展到免疫治疗之外。新型靶向药物，如成纤维细胞生长因子受体抑制剂 erdafitinib 以及两种抗体药物偶联物 enfortumab vedotin 和 sacituzumab govitecan，最近已获得批准。随着新药物的发现，评估治疗效果以及对患者生活质量的影响将非常重要。此外，整合遗传和分子信息可以帮助指导治疗决策，因为在评估新诊断的晚期和转移性癌症患者时，下一代测序越来越常见。
