开关维持治疗在尿路上皮癌中的作用。

IF 2.6 4区 医学 Q2 UROLOGY & NEPHROLOGY Therapeutic Advances in Urology Pub Date : 2023-01-13 eCollection Date: 2023-01-01 DOI:10.1177/17562872221147760
Eun-Mi Yu, Mythri Mudireddy, Rakesh Biswas, Jeanny B Aragon-Ching
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引用次数: 3

摘要

免疫检查点抑制剂(ICIs)的维持治疗改变了转移性尿路上皮癌(mUC)的治疗模式。JAVELIN膀胱100试验确定了阿维鲁单抗,这是目前使用的几种ICI之一,是晚期尿路上皮癌患者的一种延长生命的维持疗法。基于铂的化疗最常用于mUC的一线治疗,虽然有效率接近50%,但在完成标准的三到六个周期的化疗后,疾病控制通常是短暂的。近年来,在铂类化疗后疾病进展时,在符合条件的患者中使用ICIs、抗体-药物偶联物(ADC)和酪氨酸激酶抑制剂(TKIs),在二线及其他领域取得了很大进展。然而,许多一线化疗后进行性mUC患者的疾病进展迅速,后续治疗方案的治疗毒性大,预期寿命有限。在2020年JAVELIN膀胱100试验的结果公布之前,在使用一线铂类化疗实现疾病控制后,没有任何维持策略被证明比最佳支持性护理有益。到目前为止,转移性尿路上皮癌症的一线治疗标准仍然是四到六个周期的基于铂的化疗,然后维持阿维鲁单抗。这篇综述总结了mUC维持治疗的现有证据,以及几项备受期待的临床试验,我们希望这些试验将在这种侵袭性癌症的管理方面取得进一步进展,并改善患者的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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The role of switch maintenance therapy in urothelial cancers.

Maintenance therapy with immune checkpoint inhibitors (ICIs) has changed the treatment paradigm of metastatic urothelial carcinoma (mUC). The JAVELIN Bladder 100 trial established avelumab, one of several ICIs in use today, as a life-prolonging maintenance therapy for patients with advanced urothelial carcinoma. Platinum-based chemotherapy is most often used in the first-line treatment of mUC, and while response rates approach about 50%, disease control is usually short-lived upon completion of the standard three to six cycles of chemotherapy. Much progress has been made in recent years in the second-line space and beyond with the use of ICIs, antibody-drug conjugates (ADCs), and tyrosine kinase inhibitors (TKIs) in eligible patients at the time of disease progression post-platinum-based chemotherapy. However, many patients with progressive mUC after first-line chemotherapy suffer from rapid progression of disease, treatment toxicity with subsequent lines of therapy, and a limited life expectancy. Until the results of the JAVELIN Bladder 100 trial were presented in 2020, there were no maintenance strategies proven to be beneficial over best supportive care after disease control is achieved with first-line platinum-based chemotherapy. To date, standard of care frontline treatment of metastatic urothelial cancer remains to be four to six cycles of platinum-based chemotherapy followed by maintenance avelumab. This review summarizes the current evidence available on maintenance therapies in mUC, as well as several highly anticipated clinical trials that we hope will result in further progress in the management of this aggressive cancer and improve patient outcomes.

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来源期刊
CiteScore
3.70
自引率
0.00%
发文量
39
审稿时长
10 weeks
期刊介绍: Therapeutic Advances in Urology delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of urology. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in urology, providing a forum in print and online for publishing the highest quality articles in this area. The editors welcome articles of current interest across all areas of urology, including treatment of urological disorders, with a focus on emerging pharmacological therapies.
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