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Chemotherapie des Harnblasenkarzinoms

Systemtherapie mit reduzierter Toxizität

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Zusammenfassung

Die Polychemotherapie des Harnblasenkarzinoms nach dem MVAC-Schema war über viele Jahre als Standard beim metastasierten oder lokal fortgeschrittenen Harnblasenkarzinom akzeptiert. Da lediglich ein geringer Prozentsatz der Patienten mit fortgeschrittener Erkrankung durch die Chemotherapie geheilt wird, ist eine Abwägung von Nutzen und Risiko bedeutend. Ziel ist es, Patienten zu identifizieren, die auf eine Chemotherapie vermutlich ansprechen. Gleichzeitig muss die Toxizität, insbesondere bei geschwächten oder älteren Patienten, berücksichtigt werden.

Durch die Einführung innovativer Substanzen und Substanzkombinationen in die Behandlung des fortgeschrittenen Harnblasenkarzinoms haben sich vielversprechende neue Möglichkeiten eröffnet. Insbesondere hat die gute Wirksamkeit und Verträglichkeit des synthetischen Nukleosidanalogons Gemcitabine zu einer erweiterten Indikationsstellung, auch beim älteren Patienten, geführt. Bei dieser Patientengruppe können Monotherapien mit Gemcitabine aber auch mit Paclitaxel sowie Kombinationen mit Cisplatin, Carboplatin oder Methotrexat, mit vertretbarem Nebenwirkungsprofil durchgeführt werden.

Abstract

For many years, MVAC chemotherapy has been the standard treatment for patients with advanced bladder cancer. Since only a small proportion of patients with advanced disease may be cured by chemotherapy, the expected toxicity profile has to be balanced against the clinical benefit. It is of importance to select patients who may probably respond to chemotherapy.

The treatment-associated toxicity needs to be considered especially in unfit and elderly patients. The introduction of innovative new compounds and combinations for the treatment of advanced bladder cancer has opened new avenues. In particular, the good activity of the synthetic nucleoside analogue gemcitabine has improved chemotherapeutic approaches for older patients. For this group of patients, monotherapy with gemcitabine or paclitaxel as well as combinations with cisplatin, carboplatin, or methotrexate is feasible with acceptable side effects.

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Authors and Affiliations

  1. Klinik für Urologie und Kinderurologie, Urologische Universitätsklinik, Ulm

    J. E. Gschwend, J. Simon, B. Volkmer & R. E. Hautmann

  2. Klinik für Urologie und Kinderurologie, Urologische Universitätsklinik, Prittwitz-Straße 43, 89075, Ulm

    J. E. Gschwend

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  1. J. E. Gschwend
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  2. J. Simon
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  3. B. Volkmer
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  4. R. E. Hautmann
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Correspondence to J. E. Gschwend.

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Gschwend, J.E., Simon, J., Volkmer, B. et al. Chemotherapie des Harnblasenkarzinoms. Urologe [A] 42, 1445–1449 (2003). https://doi.org/10.1007/s00120-003-0451-z

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