Ning Wei, Chang Pengkang, Zheng Ji, Chen Wei
Department of Urology, Urologic Surgery Center, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
Front Immunol. 2024 Dec 18;15:1485744. doi: 10.3389/fimmu.2024.1485744. eCollection 2024.
Radical cystectomy (RC) combined with pelvic lymph node dissection (PLND) is the standard treatment for muscle-invasive bladder cancer (MIBC). For metastatic MIBC patients, platinum-based chemotherapy remains the first choice treatment. However, approximately 50% of patients with metastatic MIBC are ineligible for platinum-based adjuvant chemotherapy because of impaired renal function. In programmed death ligand 1 (PD-L1)-positive patients who cannot tolerate platinum-based chemotherapy, immunotherapy is recommended. Thus, a major shift is taking place in the treatment of patients with metastatic MIBC. There is currently much interest in the use of chemotherapy combined with immunotherapy and maintenance immunotherapy for the treatment of metastatic MIBC.
One patient with metastatic MIBC exhibited promising progression-free survival (PFS) and safety and had good renal function after RC and toripalimab combined with chemotherapy plus toripalimab maintenance therapy.
RC plus adjuvant therapy (toripalimab combined with chemotherapy) plus toripalimab maintenance therapy is a potential treatment option for metastatic MIBC patients who want to prolong their life. Moreover, a high tumor proportion score (TPS) of PD-L1 expression as well as CDKN2A and TP53 mutation levels may predict immunotherapy efficacy and patient prognosis.
根治性膀胱切除术（RC）联合盆腔淋巴结清扫术（PLND）是肌层浸润性膀胱癌（MIBC）的标准治疗方法。对于转移性MIBC患者，铂类化疗仍然是首选治疗方法。然而，约50%的转移性MIBC患者因肾功能受损而不符合铂类辅助化疗的条件。对于无法耐受铂类化疗的程序性死亡配体1（PD-L1）阳性患者，推荐免疫治疗。因此，转移性MIBC患者的治疗正在发生重大转变。目前，化疗联合免疫治疗以及维持免疫治疗用于治疗转移性MIBC备受关注。
1例转移性MIBC患者在接受RC以及托瑞帕利单抗联合化疗加托瑞帕利单抗维持治疗后，展现出了有前景的无进展生存期（PFS）和安全性，且肾功能良好。
RC加辅助治疗（托瑞帕利单抗联合化疗）加托瑞帕利单抗维持治疗是想要延长生命的转移性MIBC患者的一种潜在治疗选择。此外，PD-L1表达的高肿瘤比例评分（TPS）以及CDKN2A和TP53突变水平可能预测免疫治疗疗效和患者预后。
