SEOM-SOGUG clinical guideline for localized muscle invasive and advanced bladder cancer (2021)

被引：12

作者：

Valderrama, Begona P. ^{[1
]}

Gonzalez-del-Alba, Aranzazu ^{[2
]}

Morales-Barrera, Rafael ^{[3
]}

Pelaez Fernandez, Ignacio ^{[4
]}

Vazquez, Sergio ^{[5
]}

Caballero Diaz, Cristina ^{[6
]}

Domenech, Montserrat ^{[7
]}

Fernandez Calvo, Ovidio ^{[8
]}

de Liano Lista, Alfonso Gomez ^{[9
]}

Arranz Arija, Jose Angel ^{[10
]}

机构：

[1] Hosp Univ Virgen del Rocio, Med Oncol Dept, Av Manuel Siurot S-N, Seville 41013, Spain

[2] Hosp Univ Puerta de Hierro Majadahonda, Med Oncol Dept, Madrid, Spain

[3] Vall dHebron Univ Hosp, Vall dHebron Inst Oncol, Med Oncol Dept, Barcelona, Spain

[4] Hosp Univ Cabuenes, Med Oncol Dept, Gijon, Asturias, Spain

[5] Hosp Univ Lucus Augusti, Med Oncol Dept, Lugo, Spain

[6] Hosp Gen Univ Valencia, Med Oncol Dept, CIBERONC Ctr Invest Biomed Red Canc, Valencia, Spain

[7] Hosp Fundacio Althaia, Med Oncol Dept, Med Oncol Serv, Manresa, Spain

[8] Complejo Hosp Univ, Med Oncol Dept, Orense, Spain

[9] Complejo Hosp Univ Insular Materno Infantil, Med Oncol Dept, Las Palmas Gran Canaria, Spain

[10] Hosp Gen Univ Gregorio Maranon, Med Oncol Dept, Madrid, Spain

来源：

CLINICAL & TRANSLATIONAL ONCOLOGY | 2022年 / 24卷 / 04期

关键词：

Bladder cancer; Urothelial; Muscle-invasive; TRANSITIONAL-CELL CARCINOMA; PHASE-III TRIAL; METASTATIC UROTHELIAL CARCINOMA; LONG-TERM-SURVIVAL; NEOADJUVANT CHEMOTHERAPY; RADICAL CYSTECTOMY; ADJUVANT CHEMOTHERAPY; PROGNOSTIC-FACTORS; OPEN-LABEL; CISPLATIN;

D O I：

10.1007/s12094-022-02815-w

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Most muscle-invasive bladder cancer (BC) are urothelial carcinomas (UC) of transitional origin, although histological variants of UC have been recognized. Smoking is the most important risk factor in developed countries, and the basis for prevention. UC harbors high number of genomic aberrations that make possible targeted therapies. Based on molecular features, a consensus classification identified six different MIBC subtypes. Hematuria and irritative bladder symptoms, CT scan, cystoscopy and transurethral resection are the basis for diagnosis. Radical cystectomy with pelvic lymphadenectomy is the standard approach for muscle-invasive BC, although bladder preservation is an option for selected patients who wish to avoid or cannot tolerate surgery. Perioperative cisplatin-based neoadjuvant chemotherapy is recommended for cT2-4aN0M0 tumors, or as adjuvant in patients with pT3/4 and or pN + after radical cystectomy. Follow-up is particularly important after the availability of new salvage therapies. It should be individualized and adapted to the risk of recurrence. Cisplatin-gemcitabine is considered the standard first line for metastatic tumors. Carboplatin should replace cisplatin in cisplatin-ineligible patients. According to the EMA label, pembrolizumab or atezolizumab could be an option in cisplatin-ineligible patients with high PD-L1 expression. For patients whose disease respond or did not progress after first-line platinum chemotherapy, maintenance with avelumab prolongs survival with respect to the best supportive care. Pembrolizumab also increases survival versus vinflunine or taxanes in patients with progression after chemotherapy who have not received avelumab, as well as enfortumab vedotin in those progressing to first-line chemotherapy followed by an antiPDL1/PD1. Erdafitinib may be considered in this setting in patients with FGFR alterations. An early onset of supportive and palliative care is always strongly recommended.

引用

页码：613 / 624

页数：12