Abidoye Oluseyi, Jain Prateek, Singh Parminder
Division of Hematology and Oncology, Mayo Clinic Arizona, Phoenix, AZ.
JCO Oncol Pract. 2025 Apr 4:OP2400758. doi: 10.1200/OP-24-00758.
Urothelial carcinoma (UC) is the most common malignancy of the urinary tract, with urothelial bladder cancer accounting for approximately 90% of cases. Metastatic UC (mUC) is a particularly aggressive subset that presents significant treatment challenges, especially in patients who are often older than 70 years and have multiple comorbidities. For several decades, cisplatin-based chemotherapy has been the standard first-line treatment for locally advanced (LA) mUC. However, its utility has been limited as many patients are ineligible owing to their health status, and overall survival rates remain suboptimal. Recent advancements, including antibody-drug conjugates and immunotherapies, have begun to reshape the treatment landscape for LA/mUC. The combination of enfortumab vedotin and pembrolizumab has shown promising clinical outcomes. The approval of multiple novel drugs and combination therapies not only provides new opportunities for patient care but also creates the need for physicians to adapt to this evolving therapeutic paradigm. This review explores the latest clinical data on the management of LA/mUC and offers insights into sequencing therapies for patients with LA/mUC.
尿路上皮癌（UC）是最常见的泌尿系统恶性肿瘤，其中膀胱尿路上皮癌约占病例的90%。转移性UC（mUC）是一种特别侵袭性的亚型，带来了重大的治疗挑战，尤其是在通常年龄超过70岁且有多种合并症的患者中。几十年来，以顺铂为基础的化疗一直是局部晚期（LA）mUC的标准一线治疗方法。然而，其效用有限，因为许多患者由于健康状况而不符合条件，总体生存率仍然不理想。最近的进展，包括抗体药物偶联物和免疫疗法，已经开始重塑LA/mUC的治疗格局。恩杂鲁胺和帕博利珠单抗的联合使用已显示出有前景的临床结果。多种新型药物和联合疗法的获批不仅为患者护理提供了新机会，也使医生需要适应这种不断演变的治疗模式。本综述探讨了LA/mUC管理的最新临床数据，并为LA/mUC患者的序贯治疗提供见解。
