Guimarães Marcela G B, Miranda Thiago A, Haum Fernanda N C, Pereira Gabriel Clemente B, Girardi Daniel M
Department of Medical Oncology, Hospital Sírio-Libanês, Brasília, Brazil; Department of Medical Oncology, Hospital de Base do Distrito Federal, Brasília, Brazil.
Department of Medical Oncology, Hospital Sírio-Libanês, Brasília, Brazil.
Chin Clin Oncol. 2024 Dec;13(6):86. doi: 10.21037/cco-24-67.
Urothelial carcinoma poses significant challenges in clinical management due to its aggressive nature and high prevalence. While most diagnoses involve localized disease, advanced urothelial carcinoma (aUC) often leads to short overall survival (OS). Historically, platinum-based chemotherapy has been the primary treatment for aUC, although its efficacy is limited. However, recent therapeutic advancements, such as immune checkpoint inhibitors (ICIs) and targeted therapy using antibody-drug conjugates (ADCs) and tyrosine kinase inhibitors (TKIs), have shown promise in clinical trials, initially among patients who have undergone platinum-based chemotherapy. Recently, phase III clinical trials have assessed the effectiveness of ICIs, ADCs, and TKIs either in combination or as monotherapy in the first line setting for patients with aUC. As a result of this expanding knowledge, the combination of enfortumab vedotin (EV) with pembrolizumab in the front-line scenario became the new standard of care for aUC, demonstrating significant enhancements in OS and progression-free survival compared to platinum-based chemotherapy. Additionally, other ADCs and targeted therapies have exhibited promising efficacy in clinical trials. This review summarizes recent advancements in the treatment landscape of aUC, focusing on the efficacy and safety profiles of ICIs, ADCs, and TKIs, highlighting the evolving standards and promising combination approaches in the management of this challenging malignancy.
尿路上皮癌因其侵袭性和高发病率，在临床管理中面临重大挑战。虽然大多数诊断涉及局限性疾病，但晚期尿路上皮癌（aUC）通常导致总体生存期（OS）较短。从历史上看，铂类化疗一直是aUC的主要治疗方法，但其疗效有限。然而，最近的治疗进展，如免疫检查点抑制剂（ICIs）以及使用抗体药物偶联物（ADCs）和酪氨酸激酶抑制剂（TKIs）的靶向治疗，在临床试验中已显示出前景，最初是在接受铂类化疗的患者中。最近，III期临床试验评估了ICIs、ADCs和TKIs在aUC患者一线治疗中联合使用或单药治疗的有效性。由于这方面知识的不断扩展，一线使用恩杂鲁胺（EV）与帕博利珠单抗联合治疗成为aUC的新护理标准，与铂类化疗相比，在OS和无进展生存期方面有显著改善。此外，其他ADCs和靶向治疗在临床试验中也显示出有前景的疗效。本综述总结了aUC治疗领域的最新进展，重点关注ICIs、ADCs和TKIs的疗效和安全性，强调了在这种具有挑战性的恶性肿瘤管理中不断演变的标准和有前景的联合治疗方法。
