Ehrlich Matthew I, Fox Robert D, Runcie Karie D, Stein Mark N, Wei Alexander Z
Division of Hematology & Oncology, Columbia University Irving Medical Center, New York, NY 10032, USA.
Cancers (Basel). 2025 Jun 20;17(13):2070. doi: 10.3390/cancers17132070.
To summarize the relevant trials relating to novel strategies and therapeutic advances in the treatment of bladder cancer. A comprehensive review of the literature and recent/ongoing clinical trials was conducted, focusing on novel treatments and strategies for bladder cancer. Trials started or published as of 2020 were included. The standard of care for MIBC remains neoadjuvant chemotherapy with perioperative immunotherapy in the cisplatin-eligible population, while guidelines do not exist for cisplatin-ineligible patients. Strategies under investigation include combinations of chemotherapy, immunotherapy, radiation, and/or novel therapies, such as ADCs, targeted agents, intravesical treatments, and personalized vaccines. Bladder-sparing approaches using these novel therapies are also being studied. In the advanced/metastatic setting, enfortumab vedotin plus pembrolizumab has supplanted platinum-based chemotherapy as the first-line treatment option. For those with contraindications, or who progress, strategies under investigation include newer immunotherapies and ADCs, novel small molecule inhibitors, and cellular therapies. The treatment landscape for bladder cancer has changed drastically within the last few years. Ongoing trials hope to build on this success by investigating bladder-sparing strategies for MIBC and novel systemic therapies in advanced patients.
总结与膀胱癌治疗中的新策略和治疗进展相关的试验。对文献及近期/正在进行的临床试验进行了全面回顾，重点关注膀胱癌的新治疗方法和策略。纳入了截至2020年启动或发表的试验。肌层浸润性膀胱癌（MIBC）的标准治疗方案仍是对符合顺铂治疗条件的患者进行新辅助化疗及围手术期免疫治疗，而对于不符合顺铂治疗条件的患者则没有相关指南。正在研究的策略包括化疗、免疫治疗、放疗和/或新疗法的联合应用，如抗体药物偶联物（ADCs）、靶向药物、膀胱内治疗和个性化疫苗。使用这些新疗法的保留膀胱方法也在研究中。在晚期/转移性膀胱癌的治疗中，恩杂鲁胺联合帕博利珠单抗已取代铂类化疗成为一线治疗选择。对于有禁忌证或病情进展的患者，正在研究的策略包括更新的免疫疗法和ADC、新型小分子抑制剂以及细胞疗法。在过去几年中，膀胱癌的治疗格局发生了巨大变化。正在进行的试验希望通过研究MIBC的保留膀胱策略和晚期患者的新型全身疗法，在此基础上取得更大成功。
