Das Hochrisiko-nicht-muskelinvasive-Harnblasenkarzinom (HR-NMIBC) in Zeiten des BCG-Mangels: was für Optionen haben wir?

Zusammenfassung

Das Hochrisiko-NMIBC ist eine Herausforderung, da es zwar noch nicht muskelinvasiv ist, aber eine hohe Progressionsneigung aufweist. Eine Erfassung der Prognosegruppe ist wichtig und über Nomogramme empfohlen. Neben einer gründlichen transurethralen Resektion empfiehlt sich eine adjuvante Therapie mit BCG, was momentan teils aber nur eingeschränkt verfügbar ist. Daneben ist eine hypertherme Chemotherapie untersucht, deren Datenbasis zum jetzigen Zeitpunkt aber keine breite Anwendung rechtfertigt. Neue Ansätze wie die Checkpoint-Blockade-Inhibition werden untersucht, bieten aber keine Möglichkeit zur breiten praktischen Anwendung bei uns. Eine radikale Zystektomie ist daher in Anbetracht der hohen Progressionsneigung bei ungünstiger Tumorkonstellation immer zu indizieren.

Abstract

High-risk NMIBC is challenging since, although not being muscle-invasive, it is characterised by a high propensity for progression. It is important to determine the prognostic group, which should be done by means of nomograms. Following thorough transurethral resection, adjuvant therapy with BCG is a standard treatment, but BCG is partly unavailable at present due to shortage. Hyperthermic chemotherapy has also been studied, but its broad use is not yet justified based on the data currently available, which also holds true for checkpoint blockade inhibition. Therefore, given the high propensity for progression, early cystectomy is indicated in case of adverse tumour features.

Schlüsselwörter

Hochrisiko-nicht-muskelinvasives-Harnblasenkarzinom - BCG - intravesikale Chemotherapie - Frühzystektomie

Keywords

BCG - intravesical chemotherapy - early cystectomy - high-risk non-muscle-invasive bladder cancer

Publication History

Article published online:
15 July 2020

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