Aktuelle Systemtherapie des Urothelkarzinoms

Zusammenfassung

Eine perioperative Chemotherapie verbessert wahrscheinlich sowohl in einem neoadjuvanten als auch in einem adjuvanten Konzept das Überleben des Patienten. Damit ist sie ein integraler Teil der modernen Therapie von Patienten mit einem muskelinvasiven Harnblasenkarzinom. Jeder Patient, der für eine Cisplatin-basierte Chemotherapie geeignet ist, sollte in ein entsprechendes Konzept eingebunden werden.

Standard sowohl in der perioperativen als auch in der palliativen Systemtherapie des Urothelkarzinoms sind Cisplatin-basierte Kombinationstherapien. Carboplatin stellt nur bei „unfitten“ Patienten in der palliativen Therapiesituation einen möglichen Ersatz dar, in der perioperativen Systemtherapie besitz es keinen Stellenwert. Im Falle eines Rezidivs nach einer palliativen Erstlinientherapie oder bei einem schnellen Progress nach perioperativer Therapie kann eine Zweitlinientherapie mit Vinflunin durchgeführt werden. Alternativ dazu können auch Taxane oder Taxan-basierte Kombinationen zum Einsatz kommen.

Neue Therapiemöglichkeiten sind der Einsatz von Immuncheckpoint-Inhibitoren, welche in ersten Studien vielversprechende Ergebnisse zeigten. Erste Zulassungen durch die FDA sind für die Therapie des metastasierten/fortgeschrittenen Urothelkarzinoms bereits erfolgt. Andere zukünftige Optionen sind „maßgeschneiderte“ Therapiekonzepte, die auf der Molekularpathogenese des individuellen Patienten beruhen. Hier sind jedoch noch weitreichende präklinische Arbeiten erforderlich.

Abstract

Perioperative chemotherapy is likely to improve survival in both the neoadjuvant and the adjuvant setting. Therefore, it is an integral part of the modern treatment of patients with muscle-invasive urothelial bladder cancer. All patients who are suitable for cisplatin-based chemotherapy should be involved in a corresponding concept.

Cisplatin-based combinations are standard regimens in the perioperative and palliative systemic treatment of urothelial cancer. Carboplatin is only an inferior substitute for "unfit" patients in the palliative treatment situation.

Vinflunine may be used as a second-line agent in case of recurrence after palliative first-line treatment or in patients presenting with rapid progression after perioperative treatment. Alternatively, taxane or taxane-based combinations can be used in these situations.

New therapeutic options may include the use of immune checkpoint inhibitors, which have shown promising results in early studies. Two substances have already been approved by the FDA for the treatment of advanced/metastatic urothelial cancer following platin-based upfront treatment. Other future options may be "tailored" treatment concepts based on the molecular pathogenesis of the individual patient. However, extensive pre-clinical work is still required for this approach.

Schlüsselwörter

Urothelkarzinom - Chemotherapie - Immun-Checkpoint Blockade - zielgerichtete Tumortherapie - prognostische Faktoren

Key words

urothelial cancer - chemotherapy - immune checkpoint inhibition - targeted therapy - prognostic factors

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