Chemotherapie des Urothelkarzinoms der Harnblase – Update 2012

Zusammenfassung

Etwa die Hälfte der Patienten mit einem muskelinvasiven Urothelkarzinom der Harnblase weist trotz radikaler Zystektomie mit pelviner Lymphadenektomie im weiteren Verlauf ein Rezidiv auf. Durch den Einsatz einer neoadjuvanten Chemotherapie wird das tumorspezifische und das Gesamtüberleben der Patienten verbessert, auch wenn es bislang noch nicht möglich ist, zu definieren, welcher Patient tatsächlich von einem neoadjuvanten Therapieregime profitiert und welcher nicht. Die Wirksamkeit einer adjuvanten Behandlung ist hingegen bislang nicht belegt. Beim metastasierten Urothelkarzinom der Harnblase ist eine Chemotherapie in der Regel eine palliative Therapieoption. Dennoch kann bei einem signifikanten Anteil der Patienten eine adäquate Stabilisierung des Krankheitsprogress ggf. auch mit einem Langzeitansprechen erreicht werden. Wichtige Entscheidungshilfen für die Indikation zur Chemotherapie sind dabei kürzlich identifizierte klinische Prognosefaktoren. Diese Arbeit gibt einen Überblick über die aktuellen Standards und Entwicklungen in der Chemotherapie des Urothelkarzinoms der Harnblase und soll eine Grundlage für eine sinnvolle Therapieentscheidung im klinischen Alltag sein.

Abstract

Despite adequate surgical treatment by radical cystectomy and pelvic lymphadenectomy, about half of patients suffering from muscle-invasive urothelial bladder cancer will die. Both overall and cancer-specific survival has been improved by neoadjuvant chemotherapy. However, it is still not possible to predict who is likely to benefit from neoadjuvant treatment and who will not. In contrast to neoadjuvant chemotherapy, the efficacy of adjuvant chemotherapy has not definitely been proven. In metastatic urothelial cancer chemotherapy is usually a pallia­tive treatment option. However, in a significant proportion of patients, disease stabilisation and even long-term response can be achieved. Important advances to tailor first- and second-line chemotherapy have recently been reported for clinical prognostic parameters. This review discusses the current standards and developments in the chemotherapeutic treatment of urothelial bladder cancer. Furthermore, it should provide a framework for reasonable treatment choices in daily clinical practice.

Schlüsselwörter

Urothelkarzinom - Chemotherapie - zielgerichtete Therapie - Prognosefaktoren

Key words

urothelial cancer - chemotherapy - targeted therapy - prognostic factors

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