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Immuntherapie beim lokal fortgeschrittenen und metastasierten Harnblasenkarzinom

Immunotherapy for locally advanced and metastasized bladder cancer

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Zusammenfassung

Das Harnblasenkarzinom ist in seinem fortgeschrittenen und metastasierten Stadium schwierig zu behandeln. Mehrere Faktoren spielen eine Rolle: Alter, Multimorbidität und insbesondere eingeschränkte Nierenfunktion und Neuropathien verhindern in den meisten Fällen eine lebensverlängernde chemotherapeutische Therapie. In der zweiten Linie sind Ansprechraten und Verbesserung vom Gesamtüberleben kaum unterschiedlich zu allgemeinen palliativen Maßnahmen. In den letzten beiden Jahren hat sich die therapeutische Landschaft dramatisch verändert. Immuntherapien, hauptsächlich durch Vertreter der Checkpoint-Inhibitoren, haben durch positive Studienergebnisse die EMA- (European Medicines Agency‑)Zulassungen erlangt. Sowohl in der Zweitlinie nach Platin-haltiger Chemotherapie, als auch als Erstlinientherapie beim unfitten Patienten, können diese Substanzen eingesetzt werden. Neue Konzepte mit Kombinationen aus immuntherapeutisch wirksamen Komponenten werden derzeit in vielen Studien untersucht. Optimismus macht sich breit, wenn man die Daten von anderen Karzinomen (Melanom, nichtkleinzelliges Bronchuskarzinom) verfolgt.

Abstract

Urothelial carcinoma of the bladder is difficult to treat in advanced and metastatic stages. Several factors play a role: age, multimorbidity including impaired renal function and neuropathy make access to life-prolonging chemotherapy impossible in many cases. Improvements of response rates and overall survival in the second-line setting are not much different compared to best supportive care. However, the therapeutic landscape has changed dramatically during the last 2 years. Immunotherapies represented by checkpoint inhibitors have showed positive trial outcomes and have been approved by EMA (European Medicines Agency). Both in second-line therapy after platinum-based chemotherapy and in first-line therapy in unfit patients, these drugs can be used. New concepts with combinations of immunotherapeutic compounds are currently being examined in various trials. If we follow the data of other malignancies (melanoma and non-small cell lung cancer), the future looks optimistic.

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Correspondence to W. Loidl.

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Interessenkonflikt

W. Loidl und F. Luger geben an, an folgender Studie teilgenommen zu haben: Von der Maase H, Sengelov L, Roberts JT et al.: Long-term survival results of a randomized trial comparing gemcitabine plus cisplatin, with methotrexate, vinblastine, doxorubicin, plus cisplatin in patients with bladder cancer. J Clin Oncol 2005; 23:4602.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Loidl, W., Luger, F. Immuntherapie beim lokal fortgeschrittenen und metastasierten Harnblasenkarzinom. Urologe 57, 1334–1341 (2018). https://doi.org/10.1007/s00120-018-0785-1

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  • DOI: https://doi.org/10.1007/s00120-018-0785-1

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