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Die Urologie
Erschienen in: Die Urologie 2/2021

03.01.2021 | Harnblasenkarzinom | CME

Systemtherapie des Harnblasenkarzinoms

verfasst von: Alexander Tamalunas, Gerald B. Schulz, Severin Rodler, Maria Apfelbeck, Christian G. Stief, Dr. med. Jozefina Casuscelli

Erschienen in: Die Urologie | Ausgabe 2/2021

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Zusammenfassung

Mit jährlich etwa 30.000 Neuerkrankungen ist das Harnblasenkarzinom (BC) eines der häufigsten Karzinome in Deutschland, und die Inzidenz steigt mit dem Alter. Das Urothelkarzinom stellt die häufigste histologische Variante des BC in Mitteleuropa dar. Das nichtmuskelinvasive Karzinom der Harnblase kann endourologisch reseziert und über eine intravesikale Instillationstherapie behandelt werden. Bei Voranschreiten zur muskelinvasiven Erkrankung kann eine Zystektomie mit begleitender neoadjuvanter oder adjuvanter Chemotherapie kurativ sein. Die Behandlung des metastasierten BC erfolgt systemisch. Obwohl der Einsatz der Immuntherapie in den letzten Jahren große Fortschritte gemacht hat, bleibt die palliative Chemotherapie nach wie vor der Goldstandard. Dabei entwickelt sich das Armamentarium weiter: Die Immuntherapie wird sowohl beim nichtmuskelinvasiven BC als auch in der perioperativen Behandlung sowie in der Erhaltungstherapie nach Chemotherapie untersucht, und es laufen Studien zu neuen zielgerichteten Wirkstoffen für die palliative Systemtherapie. Diese Neuerungen und der zu erwartende Paradigmenwechsel der Systemtherapie des BC werden in diesem Beitrag beleuchtet.
Literatur
1.
Collaboration, A.B.C.A.M.-a (2005) Neoadjuvant chemotherapy in invasive bladder cancer: update of a systematic review and meta-analysis of individual patient data advanced bladder cancer (ABC) meta-analysis collaboration. Eur Urol 48(2):202–205 (discussion 205–6)CrossRef
2.
Hermans TJN et al (2016) Perioperative treatment and radical cystectomy for bladder cancer—a population based trend analysis of 10,338 patients in the Netherlands. Eur J Cancer 54:18–26PubMedCrossRef
3.
Yin M et al (2016) Neoadjuvant chemotherapy for muscle-invasive bladder cancer: a systematic review and two-step meta-analysis. Oncologist 21(6):708–715PubMedPubMedCentralCrossRef
4.
Dong H et al (2002) Tumor-associated B7-H1 promotes T‑cell apoptosis: a potential mechanism of immune evasion. Nat Med 8(8):793–800PubMedCrossRef
5.
6.
7.
Sternberg CN et al (2007) Chemotherapy for bladder cancer: treatment guidelines for neoadjuvant chemotherapy, bladder preservation, adjuvant chemotherapy, and metastatic cancer. Urology 69(1 Suppl):62–79PubMedCrossRef
8.
Sato PA et al (2002) Monitoring anthrax vaccine safety in US military service members on active duty: surveillance of 1998 hospitalizations in temporal association with anthrax immunization. Vaccine 20(17–18):2369–2374PubMedCrossRef
9.
Hussain SA et al (2012) A study of split-dose cisplatin-based neo-adjuvant chemotherapy in muscle-invasive bladder cancer. Oncol Lett 3(4):855–859PubMedPubMedCentral
10.
Loehrer PJ Sr. et al (1992) A randomized comparison of cisplatin alone or in combination with methotrexate, vinblastine, and doxorubicin in patients with metastatic urothelial carcinoma: a cooperative group study. J Clin Oncol 10(7):1066–1073PubMedCrossRef
11.
Grossman HB et al (2003) Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med 349(9):859–866PubMedCrossRef
12.
Martini T et al (2017) The use of neoadjuvant chemotherapy in patients with Urothelial carcinoma of the bladder: current practice among clinicians. Clin Genitourin Cancer 15(3):356–362PubMedCrossRef
13.
Galsky MD et al (2011) A consensus definition of patients with metastatic urothelial carcinoma who are unfit for cisplatin-based chemotherapy. Lancet Oncol 12(3):211–214PubMedCrossRef
14.
Powles T et al (2019) Clinical efficacy and biomarker analysis of neoadjuvant atezolizumab in operable urothelial carcinoma in the ABACUS trial. Nat Med 25(11):1706–1714PubMedCrossRef
15.
Necchi A et al (2020) Updated results of PURE-01 with preliminary activity of neoadjuvant pembrolizumab in patients with muscle-invasive bladder carcinoma with variant Histologies. Eur Urol 77(4):439–446PubMedCrossRef
16.
Galsky MD et al (2016) Effectiveness of adjuvant chemotherapy for locally advanced bladder cancer. J Clin Oncol 34(8):825–832PubMedCrossRef
17.
Sternberg CN et al (2015) Immediate versus deferred chemotherapy after radical cystectomy in patients with pT3-pT4 or N+ M0 urothelial carcinoma of the bladder (EORTC 30994): an intergroup, open-label, randomised phase 3 trial. Lancet Oncol 16(1):76–86PubMedCrossRef
18.
von der Maase H et al (2000) Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol 18(17):3068–3077PubMedCrossRef
19.
Leow JJ et al (2014) Adjuvant chemotherapy for invasive bladder cancer: a 2013 updated systematic review and meta-analysis of randomized trials. Eur Urol 66(1):42–54PubMedCrossRef
20.
21.
Gupta S et al (2020) Results from BLASST‑1 (Bladder Cancer Signal Seeking Trial) of nivolumab, gemcitabine, and cisplatin in muscle invasive bladder cancer (MIBC) undergoing cystectomy. J Clin Oncol 38(6_suppl):439–439CrossRef
22.
Langer CJ et al (2016) Carboplatin and pemetrexed with or without pembrolizumab for advanced, non-squamous non-small-cell lung cancer: a randomised, phase 2 cohort of the open-label KEYNOTE-021 study. Lancet Oncol 17(11):1497–1508PubMedPubMedCentralCrossRef
23.
Funt SA, Rosenberg JE (2017) Systemic, perioperative management of muscle-invasive bladder cancer and future horizons. Nat Rev Clin Oncol 14(4):221–234PubMedCrossRef
24.
Hautmann RE et al (2012) Radical cystectomy for urothelial carcinoma of the bladder without neoadjuvant or adjuvant therapy: long-term results in 1100 patients. Eur Urol 61(5):1039–1047PubMedCrossRef
25.
von der Maase H et al (2005) Long-term survival results of a randomized trial comparing gemcitabine plus cisplatin, with methotrexate, vinblastine, doxorubicin, plus cisplatin in patients with bladder cancer. J Clin Oncol 23(21):4602–4608PubMedCrossRef
26.
Bellmunt J et al (2002) Pretreatment prognostic factors for survival in patients with advanced urothelial tumors treated in a phase I/II trial with paclitaxel, cisplatin, and gemcitabine. Cancer 95(4):751–757PubMedCrossRef
27.
De Santis M et al (2012) Randomized phase II/III trial assessing gemcitabine/carboplatin and methotrexate/carboplatin/vinblastine in patients with advanced urothelial cancer who are unfit for cisplatin-based chemotherapy: EORTC study 30986. J Clin Oncol 30(2):191–199PubMedCrossRef
28.
Sternberg CN et al (2001) Chemotherapy with an every-2-week regimen of gemcitabine and paclitaxel in patients with transitional cell carcinoma who have received prior cisplatin-based therapy. Cancer 92(12):2993–2998PubMedCrossRef
29.
Meluch AA et al (2001) Paclitaxel and gemcitabine chemotherapy for advanced transitional-cell carcinoma of the urothelial tract: a phase II trial of the Minnie pearl cancer research network. J Clin Oncol 19(12):3018–3024PubMedCrossRef
30.
Dreicer R et al (1996) Paclitaxel in advanced urothelial carcinoma: its role in patients with renal insufficiency and as salvage therapy. J Urol 156(5):1606–1608PubMedCrossRef
31.
Lorusso V et al (1998) A phase II study of gemcitabine in patients with transitional cell carcinoma of the urinary tract previously treated with platinum. Italian Co-operative Group on Bladder Cancer. Eur J Cancer 34(8):1208–1212PubMedCrossRef
32.
Garcia-Donas J et al (2017) Maintenance therapy with vinflunine plus best supportive care versus best supportive care alone in patients with advanced urothelial carcinoma with a response after first-line chemotherapy (MAJA; SOGUG 2011/02): a multicentre, randomised, controlled, open-label, phase 2 trial. Lancet Oncol 18(5):672–681aPubMedCrossRef
33.
Bellmunt J et al (2009) Phase III trial of vinflunine plus best supportive care compared with best supportive care alone after a platinum-containing regimen in patients with advanced transitional cell carcinoma of the urothelial tract. J Clin Oncol 27(27):4454–4461PubMedCrossRef
34.
Powles T et al (2014) MPDL3280A (anti-PD-L1) treatment leads to clinical activity in metastatic bladder cancer. Nature 515(7528):558–562CrossRefPubMed
35.
Balar AV et al (2017) Atezolizumab as first-line treatment in cisplatin-ineligible patients with locally advanced and metastatic urothelial carcinoma: a single-arm, multicentre, phase 2 trial. Lancet 389(10064):67–76PubMedCrossRef
36.
O’Donnell PH et al (2019) KEYNOTE-052: Phase 2 study evaluating first-line pembrolizumab (pembro) in cisplatin-ineligible advanced urothelial cancer (UC)—Updated response and survival results. J Clin Oncol 37(15_suppl):4546–4546CrossRef
37.
38.
Sharma P et al (2016) Nivolumab monotherapy in recurrent metastatic urothelial carcinoma (CheckMate 032): a multicentre, open-label, two-stage, multi-arm, phase 1/2 trial. Lancet Oncol 17(11):1590–1598PubMedPubMedCentralCrossRef
39.
Plimack ER et al (2017) Safety and activity of pembrolizumab in patients with locally advanced or metastatic urothelial cancer (KEYNOTE-012): a non-randomised, open-label, phase 1b study. Lancet Oncol 18(2):212–220PubMedCrossRef
40.
Powles T et al (2018) Atezolizumab versus chemotherapy in patients with platinum-treated locally advanced or metastatic urothelial carcinoma (IMvigor211): a multicentre, open-label, phase 3 randomised controlled trial. Lancet 391(10122):748–757CrossRefPubMed
41.
Massard C et al (2016) Safety and efficacy of durvalumab (MEDI4736), an anti-programmed cell death ligand‑1 immune checkpoint inhibitor, in patients with advanced Urothelial bladder cancer. J Clin Oncol 34(26):3119–3125PubMedPubMedCentralCrossRef
42.
Powles T et al (2017) Efficacy and safety of durvalumab in locally advanced or metastatic urothelial carcinoma: updated results from a phase 1/2 open-label study. JAMA Oncol 3(9):e172411PubMedPubMedCentralCrossRef
43.
Apolo A et al (2017) Updated efficacy and safety of avelumab in metastatic urothelial carcinoma (mUC): pooled analysis from 2 cohorts of the phase 1b Javelin solid tumor study. J Clin Oncol 35(15_suppl):4528CrossRef
44.
45.
46.
Sharma P et al (2017) Nivolumab in metastatic urothelial carcinoma after platinum therapy (CheckMate 275): a multicentre, single-arm, phase 2 trial. Lancet Oncol 18(3):312–322PubMedCrossRef
47.
Vaughn DJ et al (2018) Health-related quality-of-life analysis from KEYNOTE-045: a phase III study of pembrolizumab versus chemotherapy for previously treated advanced Urothelial cancer. J Clin Oncol 36(16):1579–1587PubMedCrossRef
48.
Johnson DB, Sullivan RJ, Menzies AM (2017) Immune checkpoint inhibitors in challenging populations. Cancer 123(11):1904–1911PubMedCrossRef
49.
Schulz GB et al (2020) Safety, efficacy and prognostic impact of immune checkpoint inhibitors in older patients with genitourinary cancers. J Geriatr Oncol 11(7):1061–1066PubMedCrossRef
50.
Sternberg CN et al (2019) Primary results from SAUL, a multinational single-arm safety study of atezolizumab therapy for locally advanced or metastatic urothelial or nonurothelial carcinoma of the urinary tract. Eur Urol 76(1):73–81PubMedCrossRef
51.
52.
Brahmer JR et al (2018) Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 36(17):1714–1768PubMedCrossRef
53.
Loriot Y et al (2019) Erdafitinib in locally advanced or metastatic urothelial carcinoma. N Engl J Med 381(4):338–348CrossRefPubMed
54.
Shin E et al (2020) Markedly increased ocular side effect causing severe vision deterioration after chemotherapy using new or investigational epidermal or fibroblast growth factor receptor inhibitors. BMC Ophthalmol 20(1):19PubMedPubMedCentralCrossRef
55.
Rosenberg JE et al (2019) Pivotal trial of enfortumab vedotin in urothelial carcinoma after platinum and anti-programmed death 1/programmed death Ligand 1 therapy. J Clin Oncol 37(29):2592–2600PubMedPubMedCentralCrossRef
Metadaten
Titel
Systemtherapie des Harnblasenkarzinoms
verfasst von
Alexander Tamalunas
Gerald B. Schulz
Severin Rodler
Maria Apfelbeck
Christian G. Stief
Dr. med. Jozefina Casuscelli
Publikationsdatum
03.01.2021
Verlag
Springer Medizin
Erschienen in
Die Urologie / Ausgabe 2/2021
Print ISSN: 2731-7064
Elektronische ISSN: 2731-7072
DOI
https://doi.org/10.1007/s00120-020-01420-5

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