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Stellenwert der systemische Chemotherapie des Harnblasenkarzinoms

Value of systemic chemotherapy in bladder cancer

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Zusammenfassung

Die Hälfte der Patienten mit einem muskelinvasiven Harnblasenkarzinom hat zum Zeitpunkt der initialen Diagnose bereits okkulte regionale oder Fernmetastasen. Die systemische Erkrankung hat mit weniger als 10% Langzeit-Überlebensrate eine ungünstige Prognose. Mit der systemischen Chemotherapie versucht man, den weiteren Verlauf einer lokal fortgeschrittenen oder metastasierten Erkrankung günstig zu beeinflussen. Ein Überlebensvorteil von 5% einer neoadjuvanten und 9–11% einer adjuvanten Chemotherapie ist im ersten Fall minimal, für die adjuvante Situation schon eher beachtenswert. Als induktive Chemotherapie sind das MVAC-Schema und die Kombination Gemcitabin/Cisplatin als Standardschemata anzusehen. Dennoch sind die 5-Jahres-Überlebensraten mit 15 bzw. 13% enttäuschend. Von besonderer Bedeutung sind in diesem Zusammenhang prognostische Faktoren, bei deren Berücksichtigung deutliche Unterschiede im Überleben bestehen. Hoffnungen werden in eine neue Substanzgruppe, die sog. target-spezifischen Medikamente, gesetzt, die gezielt in die Kaskade der Tumorgenese eingreifen.

Abstract

Almost half of the patients with muscle invasive disease already habor at the time of their first diagnosis occult or distant metastases. Systemic disease has a poor prognosis with a long term survival of less than 10%. The administration of systemic chemotherapy aims to improve the course of locally advanced or metastatic disease.

A survival benefit of 5% for patients receiving neoadjuvant and 9–11% using adjuvant chemotherapy is in the first scenario minimal, in the adjuvant setting to be noteworthy. The MVAC-schedule and the Gemcitabine/Cisplatin-combination chemotherapy have to be regarded as standard for induction chemotherapy. However, the 5-year survival rates with 15 or 13% are disappointing.

Thus, prognostic factors gain importance since with their consideration significant differences in survival rates can be found. Hope is provided by a novel class of substances, the target-specific drugs, which selectively interfere with the cascade of steps involved in tumorigenesis.

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Literatur

  1. Soloway MS, Ikard M, Ford K (1981) Cis-diamminedichloroplatinum (II) in locally advanced and metastatic urothelialcancer. Cancer 47: 476–480

    PubMed  Google Scholar 

  2. Fagg SL, Dawson Edwards P, Hughes MA, Latief T, Rolfe EB, Fielding JW (1984) Cis-diamminedichloroplatinum (DPP) as initial treatment of invasive bladder cancer. Br J Urol 56: 296–300

    PubMed  Google Scholar 

  3. Raghavan D, Pearson B, Coorey G (1984) Intravenous cis-platinum for invasive clinically non metastatic bladder cancer: safety and feasibiltiy of a new approach. Med J Aust 140: 276–278

    PubMed  Google Scholar 

  4. Advanced Bladder Cancer (ABC) Meta-analysis Collaboration (2003) Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis. Lancet 361: 1927–1934

    Article  PubMed  Google Scholar 

  5. Advanced Bladder Cancer (ABC) Meta-analysis Collaboration. (2005) Neoadjuvant chemotherapy in invasive bladder cancer: update of systemic review and meta-analysis of individual patient data. Advanced bladder cancer (ABC) Meta-analysis collaboration Eur Urol 48: 202–206

  6. Wallace DMA, Raghavan D, Kelly KA et al. (1991) Neo-adjuvant (Pre-emptive) Cisplatin Therapy in Invasive Transitional Cell Carcinoma of the Bladder. British Journal of Urology 67: 608–615

    PubMed  Google Scholar 

  7. Martinez-Pineiro JA, González M, Arocena F et al. (1995) Neoadjuvant Cisplatin Chemotherapy Before Radical Cystectomy in Invasive Transitional Cell Carcinoma of the Bladder: A Prospective Randomised Phase III Study. J Urol 153: 964–973

    Article  PubMed  Google Scholar 

  8. Abol-Enein H, El-Mekresh M, El-Baz M, Ghoneim MA (1997) Neo-adjuvant chemotherapy in the treatment of invasive transitional bladder cancer. A controlled prospective randomised study. British J Urol 79: 174

    Google Scholar 

  9. Raghavan D (1991) Publiziert in: [6]

  10. Malmstrom P-U, Rintala E, Wahlqvist R et al. (1996) Five Year Follow-up of a Prospective Trial of Radical Cystectomy and Neoadjuvant Chemotherapy: Nordic Cystectomy Trial 1. J Urol 155: 1903–1906

    Article  PubMed  Google Scholar 

  11. Cortesi E. Italian Randomised Trial of Neoadjuvant MVEC in Locally Advanced Bladder Cancer. Unpublished

  12. Bassi P, Pappagallo GL, Sperandio P et al. (1999) Neoadjuvant MVAC chemotherapy of invasive bladder cancer: results of a multicenter phase III trial. J Urol 161: 264A

    Article  Google Scholar 

  13. International Collaboration of Trialists on behalf of the Medical Research Council Advanced Bladder Cancer Working Party, EORTC Genito-urinary Group, Australian Bladder Cancer Study Group, National Cancer Institute of Canada Clinical Trials Group, Finnbladder, Norwegian Bladder Cancer Study Group and Club Urologico Espanol de Tratamiento Oncologico (CUETO) group (1999) Neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle-invasive bladder cancer: a randomised controlled trial. Lancet 354: 533–540

    Article  PubMed  Google Scholar 

  14. Sengeløv L, von der Maase H, Lundbech F et al. (2002) Neoadjuvant chemotherapy with cisplatin and methotrexate in patients with muscle invasive bladder tumors. Acta Oncologia 41: 447–456

    Article  Google Scholar 

  15. Sherif A, Rintala E, Mestad O et al. (2002) Neoadjuvant Cisplatin-Methotrexate Chemotherapy of Invasive Bladder Cancer. Nordic Cystectomy Trial 2. Scandinavian Journal Urology and Nephrology 6: 419–425

    Article  Google Scholar 

  16. Natale RB, Grossman HB, Blumenstein B et al. (2001) SWOG 8710 (INT-0800) Randomized Phase III Trial of Neoadjuvant MVAC + Cystectomy versus Cystectomy Alone in Patients with Locally Advanced Bladder Cancer. Proceedings of the American Society of Clin Oncol 20: 3

    Google Scholar 

  17. Coppin CML, Gospodarowicz MK, James K et al. (1996) Improved Local Control of Invasive Bladder Cancer by Concurrent Cisplatin and Preoperative or Definitive Radiation. JCO 14: 2901–2907

    Google Scholar 

  18. Shearer RJ, Chilvers CED, Bloom HJG, Bliss JM, Horwich A, Babiker A (1988) Adjuvant Chemotherapy in T3 Carcinoma of the Bladder A prospective trial: preliminary report. Br J Urol 62: 558–564

    PubMed  Google Scholar 

  19. Richards B, Bastable JRG, Freedman L, Glashan RW, Harris G, Newling DWW et al. (1983) Adjuvant chemotherapy with doxorubicin, and 5-florouracil in T3, NX, MO bladder cancer treated with radiotherapy. Br J Urol 55: 386–391

    PubMed  Google Scholar 

  20. Einstein AB, Shipley W, Coombs J, Cummings KB, Soloway MS, Hawkins I, for the National Bladder Cancer Cooperative Group (1984) Cisplatin as adjunctive treatment for invasive bladder carcinoma: Tolerance and toxicities. Urology 23: 110–117

    PubMed  Google Scholar 

  21. Skinner DG, Daniels JR, Russel CA, Lieskovsky G, Boyd SD, Krailo M et al. (1990) Adjuvant chemotherapy following cystectomy benefits patients with deeply invasive bladder cancer. Semi Urol 8: 279–284

    Google Scholar 

  22. Bono AV, Benvenuti C, Gibba A, Guazzeri S, Cosciani-Cunico S, Anselmo G et al. (1997) Adjuvant chemotherapy in locally advanced bladder cancer. Final analysis of a controlled multicentre study. Acta Urol Ital 11: 5–8

    Google Scholar 

  23. Studer UE, Bacchi M, Biedermann C, Jaeger P, Kraft R, Mazzucchelli L et al. (1994) Adjuvant Cisplatin Chemotherapy following cystectomy for bladder cancer: Results of a prospective randomised trial. J Urol 152: 81–84

    PubMed  Google Scholar 

  24. Freiha F, Reese J, Torti FM (1996) A Randomised Trial of Radical Cystectomy versus Radical Cystectomy plus Cisplatin, Vinblastine and Methotrexate Chemotherapy for Muscle Invasive Bladder Cancer. J Urol 155: 495–500

    Article  PubMed  Google Scholar 

  25. Stöckle M, Meyenburg W, Wellek S, Voges GE, Rossman M, Gertenbach U et al. (1995) Adjuvant polychemotherapy of non-organg confined bladder cancer after radical cystectomy revisited: long term results of a controlled prospective study and further clinical experience. J Urol 153: 47–52

    Article  PubMed  Google Scholar 

  26. Parmar Mahesh KB, Burdett S (1999) Neoadjuvant and adjuvant chemotherapy. In: Hall R (ed) Clinical management of bladder cancer. 1 ed. Arnold, London, pp 249–263

  27. Advanced Bladder cancer (ABC) meta analysis collaboration (2005) Adjuvant chemotherapy in invasive bladder cancer: a systemic review and meta-analysis of individual patient data. Eur Urol 48: 189–201

    Article  PubMed  Google Scholar 

  28. Sternberg CN, de Mulder PHM, Schornagel JH et al. (2001) Randomized phase III trial of high-dose-intensity methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) chemotherapy and recombinant human granulocyte colony-stimulating factor versus classic MVAC in advanced urothelial tract tumors: European Organization for Research and Treatment of Cancer Protocol No. 30924. J Clin Oncol 19: 2638–2646

    PubMed  Google Scholar 

  29. Small EJ, Lew D, Redman BG et al. (2000) Southwest Oncology Group Study of paclitaxel and carboplatin for advanced transitional-cell carcinoma: the importance of survival as a clinical trial end point. J Clin Oncol 18: 2537–2544

    PubMed  Google Scholar 

  30. Bajorin DF, McCaffrey JA, Dodd PM et al. (2000) Ifosfoamide, paclitaxel, and cisplatin for patients with advanced transitional cell carcinoma of the urothelial tract: a final report of a phase II trial evaluating two dosing schedules. Cancer 88: 1671–1678

    Article  PubMed  Google Scholar 

  31. Bellmunt J, Guillem V, Paz-Ares L et al. (2000) Phase I-II study of paclitaxel, cisplatin, and gemcitabine in advanced transitional-cell carcinoma of the urothelium. Spanish Oncology Genitourinary Group. J Clin Oncol 18: 3247–3255

    PubMed  Google Scholar 

  32. Hussain M, Vaishampayan U, Du W, Redman B, Smith DC (2001) Combination paclitaxel, carboplatin, and gemcitabine is an active treatment for advanced urothelial cancer. J Clin Oncol 19: 2527–2533

    PubMed  Google Scholar 

  33. Meluch AA, Greco FA, Burris HA et al. (2001) Paclitaxel and gemcitabine chemotherapy for advanced transitional-cell carcinoma of the urothelial tract: a phase II trial of the Minnie Pearl Cancer Research Network. J Clin Oncol 19: 3018–3024

    PubMed  Google Scholar 

  34. Sternberg CN, Calabro F, Pizzocaro G et al (2001) Chemotherapy with every-2-week gemcitabine and paclitaxel in patients with transitional cell carcinoma who have received prior cisplatin-based therapy. Cancer 92: 2993–2998

    Article  PubMed  Google Scholar 

  35. Pectasides D, Glotsos J, Bountouroglou N et al. (2002) Weekly chemotherapy with docetaxel, gemcitabine and cisplatin in advanced transitional cell urothelial cancer: a phase II trial. Ann Oncol 13: 243–250

    Article  PubMed  Google Scholar 

  36. Gitlitz BJ, Baker C, ChapmanY et al. (2003) A phase II study of gemcitabine and docetaxel therapy in patients with advanced urothelial carcinoma. Cancer 98: 1863–1869

    Article  PubMed  Google Scholar 

  37. Von der Maase H, Hansen SW, Roberts JT et al. (2000) Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin and cisplatin in advanced or metastatic bladder cancer: results of a large, randomised, multinational, multicenter phase III study. J Clin Oncol 23: 4602–4608

    Article  Google Scholar 

  38. Dreicer R, Manola J, Roth BJ et al. (2004) Phase III trial of methotrexate, vinblastine, doxorubicin and cisplatin versus carboplatin and paclitaxel in patients with advanced carcinoma of the urothelium. Cancer 100: 1639–1645

    Article  PubMed  Google Scholar 

  39. Bamias A, Aravantinos G, Deliveliotis C (2004) Docetaxel and cisplatin with granulocyte colony-stimulating factor (G-CSF) versus MVAC with G-CSF in advanced urothelial carcinoma: a multicenter, randomised, phase III study from the Hellenic Cooperative Oncology Group. J Clin Oncol 22: 220–228

    Article  PubMed  Google Scholar 

  40. Von der Maase H, Sengelov L, Roberts JT et al. (2005) Long-term survival results of a randomized trial comparing gemcitabine plus cisplatin with methotrexate, vinblastine, doxocubicin, plus cisplatin in patients with bladder cancer. J Clin Oncol 23: 4602–4608

    Article  PubMed  Google Scholar 

  41. Capdeville R, Buchdunger E, Zimmermann J, Matter A (2002) Glivec (STI571, imatinib), a rationally developed, targeted anticancer drug. Nat Rev Drug Discov 1: 493–502

    Article  PubMed  Google Scholar 

  42. Hussain M, Petrylak DP, Dunn R et al. (2005) Trastuzumab, paclitaxel,carboplatin and, gemcitabine in advanced HER2-positive urothelial carcinoma: Results of a multi-center phase II NCI trial. J Clin Oncol 23: 379 (abstract 4507)

    Article  Google Scholar 

  43. Petrylak DP, Faulkner JR, van Veldhuizen PJ et al. (2003) Evaluation of ZD 1839 for advanced transitional cell carcinoma of the urothelium: A Southwest Oncology Group Trial. Proc Am Soc Clin Oncol 22: 403

    Google Scholar 

  44. Wülfing C, Machiels J, Richel D et al. (2005) A single arm, multicenter, open label, phase II study of lapatinib as 2-line treatment of patients with locally advanced/metastatic transitional cell carcinoma of the urothelial tract. J Clin Oncol 23: 422

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Westdeutsches Tumorzentrum (WTZE), Essen

    P. J. Goebell, F. vom Dorp & H. Rübben

  2. Klinik und Poliklinik für Urologie, Universitätsklinikum, Hufelandstraße 55, 45122, Essen

    P. J. Goebell, F. vom Dorp & H. Rübben

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  1. P. J. Goebell
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Goebell, P.J., vom Dorp, F. & Rübben, H. Stellenwert der systemische Chemotherapie des Harnblasenkarzinoms. Urologe 45, 586–593 (2006). https://doi.org/10.1007/s00120-006-1058-y

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