Skip to main content
Erschienen in: Die Urologie 9/2021

27.05.2021 | Harnblasenkarzinom | Fallbasierte Leitlinien

Blasenkarzinomsystemtherapie

verfasst von: M. Haas, M. Burger, M. J. Schnabel

Erschienen in: Die Urologie | Ausgabe 9/2021

Einloggen, um Zugang zu erhalten

Zusammenfassung

Die Cisplatin-basierte Polychemotherapie stellt in der Systemtherapie des muskelinvasiven Harnblasenkarzinoms („muscle-invasive bladder cancer“, MIBC) seit langer Zeit den Therapiestandard dar. In den vergangenen Jahren haben sich zudem auch Immun-Checkpoint-Inhibitoren (ICI) als Therapiealternative bei Cisplatin-ungeeigneten Patienten und in der Therapiesequenz des metastasierten Urothelkarzinoms etabliert. In diesem Artikel sollen die verfügbare Literatur und aktuelle Leitlinien anhand von zwei Patientenbeispielen aufgearbeitet werden, um so Therapieentscheidungen und Behandlungspfade in der Systemtherapie des lokal begrenzten und metastasierten Urothelkarzinoms der Harnblase aufzuzeigen und praxisrelevante Inhalte zu vermitteln.
Literatur
2.
Zurück zum Zitat Stenzl A, Penkoff H, Dajc-Sommerer E et al (2011) Detection and clinical outcome of urinary bladder cancer with 5‑aminolevulinic acid-induced fluorescence cystoscopy: a multicenter randomized, double-blind, placebo-controlled trial. Cancer 117(5):938–947. https://doi.org/10.1002/cncr.25523CrossRefPubMed Stenzl A, Penkoff H, Dajc-Sommerer E et al (2011) Detection and clinical outcome of urinary bladder cancer with 5‑aminolevulinic acid-induced fluorescence cystoscopy: a multicenter randomized, double-blind, placebo-controlled trial. Cancer 117(5):938–947. https://​doi.​org/​10.​1002/​cncr.​25523CrossRefPubMed
8.
Zurück zum Zitat Naito S, Algaba F, Babjuk M et al (2016) The Clinical Research Office of the Endourological Society (CROES) multicentre randomised trial of narrow band imaging-assisted Transurethral Resection of Bladder Tumour (TURBT) versus conventional white light imaging-assisted TURBT in primary non-muscle-invasive bladder cancer patients: trial protocol and 1‑year results. Eur Urol 70(3):506–515. https://doi.org/10.1016/j.eururo.2016.03.053CrossRefPubMed Naito S, Algaba F, Babjuk M et al (2016) The Clinical Research Office of the Endourological Society (CROES) multicentre randomised trial of narrow band imaging-assisted Transurethral Resection of Bladder Tumour (TURBT) versus conventional white light imaging-assisted TURBT in primary non-muscle-invasive bladder cancer patients: trial protocol and 1‑year results. Eur Urol 70(3):506–515. https://​doi.​org/​10.​1016/​j.​eururo.​2016.​03.​053CrossRefPubMed
11.
Zurück zum Zitat Kitamura H, Tsukamoto T, Shibata T et al (2014) Randomised phase III study of neoadjuvant chemotherapy with methotrexate, doxorubicin, vinblastine and cisplatin followed by radical cystectomy compared with radical cystectomy alone for muscle-invasive bladder cancer: Japan Clinical Oncology Group Study JCOG0209. Ann Oncol 25(6):1192–1198. https://doi.org/10.1093/annonc/mdu126CrossRefPubMed Kitamura H, Tsukamoto T, Shibata T et al (2014) Randomised phase III study of neoadjuvant chemotherapy with methotrexate, doxorubicin, vinblastine and cisplatin followed by radical cystectomy compared with radical cystectomy alone for muscle-invasive bladder cancer: Japan Clinical Oncology Group Study JCOG0209. Ann Oncol 25(6):1192–1198. https://​doi.​org/​10.​1093/​annonc/​mdu126CrossRefPubMed
14.
Zurück zum Zitat Galsky MD, Hahn NM, Rosenberg J et al (2011) Treatment of patients with metastatic urothelial cancer “unfit” for cisplatin-based chemotherapy. J Clin Oncol 29:2432–2438CrossRef Galsky MD, Hahn NM, Rosenberg J et al (2011) Treatment of patients with metastatic urothelial cancer “unfit” for cisplatin-based chemotherapy. J Clin Oncol 29:2432–2438CrossRef
15.
Zurück zum Zitat Mead GM, Russell M, Clark P et al (1998) A randomized trial comparing methotrexate and vinblastine (MV) with cisplatin, methotrexate and vinblastine (CMV) in advanced transitional cell carcinoma: results and a report on prognostic factors in a Medical Research Council study. MRC Advanced Bladder Cancer Working Party. Br J Cancer 78(8):1067–1075. https://doi.org/10.1038/bjc.1998.629CrossRefPubMedPubMedCentral Mead GM, Russell M, Clark P et al (1998) A randomized trial comparing methotrexate and vinblastine (MV) with cisplatin, methotrexate and vinblastine (CMV) in advanced transitional cell carcinoma: results and a report on prognostic factors in a Medical Research Council study. MRC Advanced Bladder Cancer Working Party. Br J Cancer 78(8):1067–1075. https://​doi.​org/​10.​1038/​bjc.​1998.​629CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Milosevic M et al (2007) Radiotherapy for bladder cancer. Urology 69:80–92CrossRef Milosevic M et al (2007) Radiotherapy for bladder cancer. Urology 69:80–92CrossRef
17.
Zurück zum Zitat Ploussard G et al (2014) Critical analysis of bladder sparing with trimodal therapy in muscle-invasive bladder cancer: a systematic review. Eur Urol 66:120–137CrossRef Ploussard G et al (2014) Critical analysis of bladder sparing with trimodal therapy in muscle-invasive bladder cancer: a systematic review. Eur Urol 66:120–137CrossRef
18.
Zurück zum Zitat Efstathiou JA et al (2012) Long-term outcomes of selective bladder preservation by combined-modality therapy for invasive bladder cancer: the MGH experience. Eur Urol 61:705–711CrossRef Efstathiou JA et al (2012) Long-term outcomes of selective bladder preservation by combined-modality therapy for invasive bladder cancer: the MGH experience. Eur Urol 61:705–711CrossRef
19.
Zurück zum Zitat James ND et al (2012) Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer. N Engl J Med 366:1477–1488CrossRef James ND et al (2012) Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer. N Engl J Med 366:1477–1488CrossRef
21.
Zurück zum Zitat Rödel C et al (2002) Combined-modality treatment and selective organ preservation in invasive bladder cancer: long-term results. J Clin Oncol 20:3061–3071CrossRef Rödel C et al (2002) Combined-modality treatment and selective organ preservation in invasive bladder cancer: long-term results. J Clin Oncol 20:3061–3071CrossRef
24.
Zurück zum Zitat Kaimakliotis HZ et al (2020) Phase II neoadjuvant (N-) gemcitabine (G) and pembrolizumab (P) for locally advanced urothelial cancer (laUC): interim results from the cisplatin (C)-ineligible cohort of GU14-188. J Clin Oncol 38:5019CrossRef Kaimakliotis HZ et al (2020) Phase II neoadjuvant (N-) gemcitabine (G) and pembrolizumab (P) for locally advanced urothelial cancer (laUC): interim results from the cisplatin (C)-ineligible cohort of GU14-188. J Clin Oncol 38:5019CrossRef
25.
Zurück zum Zitat Van Dijk N et al (2020) Biomarker analysis and updated clinical follow-up of preoperative ipilimumab (ipi) plus nivolumab (nivo) in stage III urothelial cancer (NABUCCO). J Clin Oncol 38:5020CrossRef Van Dijk N et al (2020) Biomarker analysis and updated clinical follow-up of preoperative ipilimumab (ipi) plus nivolumab (nivo) in stage III urothelial cancer (NABUCCO). J Clin Oncol 38:5020CrossRef
26.
Zurück zum Zitat Necchi A et al (2021) SURE: An open label, sequential-arm, phase II study of neoadjuvant sacituzumab govitecan (SG), and SG plus pembrolizumab (pembro) before radical cystectomy, for patients with muscle-invasive bladder cancer (MIBC) who cannot receive or refuse cisplatin-based chemotherapy. J Clin Oncol 39(suppl 6):TPS506CrossRef Necchi A et al (2021) SURE: An open label, sequential-arm, phase II study of neoadjuvant sacituzumab govitecan (SG), and SG plus pembrolizumab (pembro) before radical cystectomy, for patients with muscle-invasive bladder cancer (MIBC) who cannot receive or refuse cisplatin-based chemotherapy. J Clin Oncol 39(suppl 6):TPS506CrossRef
27.
Zurück zum Zitat Galsky MD et al (2021) Keynote-905/EV-303: Perioperative pembrolizumab or pembrolizumab plus enfortumab vedotin (EV) and cystectomy compared to cystectomy alone in cisplatin-ineligible patients with muscle-invasive bladder cancer (MIBC). J Clin Oncol 39(suppl 6):TPS507CrossRef Galsky MD et al (2021) Keynote-905/EV-303: Perioperative pembrolizumab or pembrolizumab plus enfortumab vedotin (EV) and cystectomy compared to cystectomy alone in cisplatin-ineligible patients with muscle-invasive bladder cancer (MIBC). J Clin Oncol 39(suppl 6):TPS507CrossRef
28.
Zurück zum Zitat Powles T et al (2019) A phase III, randomized, open label, multicenter, global study of efficacy and safety of durvalumab in combination with gemcitabine+ cisplatin (G+ C) for neoadjuvant treatment followed by durvalumab alone for adjuvant treatment in muscle-invasive bladder cancer (MIBC)(NIAGARA). J Clin Oncol 37(15_suppl):TPS4592CrossRef Powles T et al (2019) A phase III, randomized, open label, multicenter, global study of efficacy and safety of durvalumab in combination with gemcitabine+ cisplatin (G+ C) for neoadjuvant treatment followed by durvalumab alone for adjuvant treatment in muscle-invasive bladder cancer (MIBC)(NIAGARA). J Clin Oncol 37(15_suppl):TPS4592CrossRef
29.
Zurück zum Zitat Bajorin DF et al (2021) First results from the phase 3 CheckMate 274 trial of adjuvant nivolumab vs placebo in patients who underwent radical surgery for high-risk muscle-invasive urothelial carcinoma (MIUC). J Clin Oncol 39(suppl 6):391CrossRef Bajorin DF et al (2021) First results from the phase 3 CheckMate 274 trial of adjuvant nivolumab vs placebo in patients who underwent radical surgery for high-risk muscle-invasive urothelial carcinoma (MIUC). J Clin Oncol 39(suppl 6):391CrossRef
32.
Zurück zum Zitat Sternberg CN, de Mulder PH, Schornagel JH et al (2001) Randomized phase III trial of high-dose-intensity methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) chemotherapy and recombinant human granulocyte colony-stimulating factor versus classic MVAC in advanced urothelial tract tumors: European Organization for Research and Treatment of Cancer Protocol no. 30924. J Clin Oncol 19(10):2638–2646. https://doi.org/10.1200/JCO.2001.19.10.2638CrossRefPubMed Sternberg CN, de Mulder PH, Schornagel JH et al (2001) Randomized phase III trial of high-dose-intensity methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) chemotherapy and recombinant human granulocyte colony-stimulating factor versus classic MVAC in advanced urothelial tract tumors: European Organization for Research and Treatment of Cancer Protocol no. 30924. J Clin Oncol 19(10):2638–2646. https://​doi.​org/​10.​1200/​JCO.​2001.​19.​10.​2638CrossRefPubMed
36.
Zurück zum Zitat De Santis M, Bellmunt J, Mead G 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):191–199. https://doi.org/10.1200/JCO.2011.37.3571CrossRefPubMed De Santis M, Bellmunt J, Mead G 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):191–199. https://​doi.​org/​10.​1200/​JCO.​2011.​37.​3571CrossRefPubMed
37.
Zurück zum Zitat Powles T et al (2020) Maintenance avelumab + best supportive care (BSC) versus BSC alone after platinum-based first-line (1L) chemotherapy in advanced urothelial carcinoma (UC): JAVELIN Bladder 100 phase III interim analysis. J Clin Oncol 38:LBA1CrossRef Powles T et al (2020) Maintenance avelumab + best supportive care (BSC) versus BSC alone after platinum-based first-line (1L) chemotherapy in advanced urothelial carcinoma (UC): JAVELIN Bladder 100 phase III interim analysis. J Clin Oncol 38:LBA1CrossRef
39.
Zurück zum Zitat Bellmunt J, Théodore C, Demkov T 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):4454–4461. https://doi.org/10.1200/JCO.2008.20.5534CrossRefPubMed Bellmunt J, Théodore C, Demkov T 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):4454–4461. https://​doi.​org/​10.​1200/​JCO.​2008.​20.​5534CrossRefPubMed
40.
Zurück zum Zitat Bellmunt J, Fougeray R, Rosenberg JE et al (2013) Long-term survival results of a randomized phase III trial of vinflunine plus best supportive care versus best supportive care alone in advanced urothelial carcinoma patients after failure of platinum-based chemotherapy. Ann Oncol 24(6):1466–1472. https://doi.org/10.1093/annonc/mdt007CrossRefPubMed Bellmunt J, Fougeray R, Rosenberg JE et al (2013) Long-term survival results of a randomized phase III trial of vinflunine plus best supportive care versus best supportive care alone in advanced urothelial carcinoma patients after failure of platinum-based chemotherapy. Ann Oncol 24(6):1466–1472. https://​doi.​org/​10.​1093/​annonc/​mdt007CrossRefPubMed
42.
Zurück zum Zitat Galsky MD et al (2021) A phase III, randomized, open-label, multicenter, global study of first-line durvalumab plus standard of care (SoC) chemotherapy and durvalumab plus tremelimumab, and SoC chemotherapy versus SoC chemotherapy alone in unresectable locally advanced or metastatic urothelial cancer (NILE). J Clin Oncol 39(suppl 6):TPS504CrossRef Galsky MD et al (2021) A phase III, randomized, open-label, multicenter, global study of first-line durvalumab plus standard of care (SoC) chemotherapy and durvalumab plus tremelimumab, and SoC chemotherapy versus SoC chemotherapy alone in unresectable locally advanced or metastatic urothelial cancer (NILE). J Clin Oncol 39(suppl 6):TPS504CrossRef
43.
Zurück zum Zitat Grivas P et al (2021) TROPiCS-04: Study of sacituzumab govitecan in metastatic or locally advanced unresectable urothelial cancer that has progressed after platinum and checkpoint inhibitor therapy. J Clin Oncol 39(suppl 6):TPS498CrossRef Grivas P et al (2021) TROPiCS-04: Study of sacituzumab govitecan in metastatic or locally advanced unresectable urothelial cancer that has progressed after platinum and checkpoint inhibitor therapy. J Clin Oncol 39(suppl 6):TPS498CrossRef
44.
Zurück zum Zitat 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 37:2592–2600CrossRef 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 37:2592–2600CrossRef
45.
Zurück zum Zitat Petrylak DP et al (2019) EV-301: Phase III study to evaluate enfortumab vedotin (EV) versus chemotherapy in patients with previously treated locally advanced or metastatic urothelial cancer (la/mUC). J Clin Oncol 37:TPS497CrossRef Petrylak DP et al (2019) EV-301: Phase III study to evaluate enfortumab vedotin (EV) versus chemotherapy in patients with previously treated locally advanced or metastatic urothelial cancer (la/mUC). J Clin Oncol 37:TPS497CrossRef
Metadaten
Titel
Blasenkarzinomsystemtherapie
verfasst von
M. Haas
M. Burger
M. J. Schnabel
Publikationsdatum
27.05.2021
Verlag
Springer Medizin
Erschienen in
Die Urologie / Ausgabe 9/2021
Print ISSN: 2731-7064
Elektronische ISSN: 2731-7072
DOI
https://doi.org/10.1007/s00120-021-01535-3

Weitere Artikel der Ausgabe 9/2021

Die Urologie 9/2021 Zur Ausgabe

Berufspolitik BvDU

Berufspolitik BvDU

Termine

Termine

GeSRU

GeSRU

Passend zum Thema

ANZEIGE

Neue ESMO-Clinical Practice Guidelines 2023 zum fortgeschrittenen mNSCLC

Mit dem Update der Clinical Practice Guidelines 2023 zum metastasierenden nicht-kleinzelligen Lungenkarzinom (mNSCLC) trägt die ESMO der in den letzten Jahren immer weiter gewachsenen Anzahl an Therapieoptionen Rechnung. 

ANZEIGE

NOVUM Onkologie – Fortbildungsreihe zum NSCLC

Mit NOVUM Onkologie veranstaltet MSD regelmäßig Online-Fortbildungen zum Thema Lungenkarzinom. Bei dem mittlerweile etablierten Format erhalten Teilnehmende die Möglichkeit sich bei Expertendiskussionen zu praxisrelevanten Themen der pneumologischen Onkologie weiterzubilden.

ANZEIGE

Fokus Immunonkologie – NSCLC

Content Hub

Die Einführung von Immun-Checkpoint-Inhibitoren markierte einen entscheidenden Fortschritt in der Behandlung von bestimmten Patienten mit nicht-kleinzelligem Lungenkarzinom (non-small cell lung cancer, NSCLC) und eröffnete seither neue Perspektiven und Chancen für Behandler und geeignete Patienten. Hier finden Sie fortlaufend aktuelle Informationen und relevante Beiträge zur Immunonkologie in dieser Indikation.

MSD Sharp & Dohme GmbH