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Intravesikale Radioimmuntherapie des Carcinoma in situ der Harnblase nach BCG-Versagen

Intravesical radioimmunotherapy of carcinoma in situ of the urinary bladder after BCG failure

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Zusammenfassung

Hintergrund

Bei einem Carcinoma-in situ- (CIS-)Rezidiv der Harnblase nach BCG-Instillationstherapie (Bacillus Calmette-Guérin) besteht die Indikation zur radikalen Zystektomie.

Fragestellung

Im individuellen Heilversuch sollte die Verträglichkeit und Sicherheit einer Radioimmuninstillationstherapie mit dem Alpha-Strahlerkonjugat 213Bi-anti-EGFR-mAb nach BCG-Versagen bei CIS-Patienten untersucht werden.

Material und Methode

Neun Patienten wurden bislang therapiert. Nach der Blasenentleerung über den transurethralen Katheter wurde das Immunkonjugat 213Bi-anti-EGFR-mAb instilliert und für 120 min belassen. Sechs Wochen nach Instillation wurde in einer Zystoskopie mit Biopsieentnahme die Effektivität der Therapie überprüft.

Ergebnisse

Alle Patienten haben die Instillationstherapie sehr gut und ohne Nebenwirkungen vertragen. Bei 3 Patienten wurde nach 6 Wochen kein CIS mehr nachgewiesen, bei 6 Patienten zeigte sich weiterhin Tumor in der Blase.

Schlussfolgerung

Die Radioimmuntherapie mit 213Bi-anti-EGFR-mAb ist eine vielversprechende Therapieoption für Patienten mit persistierendem CIS-Nachweis nach erfolgter BCG-Instillationstherapie, die ihre Harnblase erhalten wollen.

Abstract

Background

In failure to respond to bacillus Calmette-Guérin (BCG) in patients with carcinoma in situ (CIS) of the urinary bladder, radical cystectomy remains the mainstay after BCG failure.

Objectives

The aim of this pilot study was to evaluate tolerability and safety of the α‑emitter radioimmunoconjugate instillation in patients after BCG failure.

Materials and methods

Nine patients were included. After emptying the bladder via a transurethral catheter, Bi-213-anti-EGFR-mAb was instilled. Treatment was terminated by emptying of the radioimmunoconjugate from the bladder 120 min after instillation. Efficacy was evaluated via endoscopy and histology 6 weeks after instillation.

Results

All patients showed excellent toleration of the treatment without any side effects. Treatment resulted in complete eradication of tumor cells in 3 patients and persistent tumor detection in the other 6 patients.

Conclusions

Intravesical instillation of Bi-213-anti-EGFR-mAb is a promising therapeutic option for treatment of in situ bladder cancer after BCG failure for patients who wish to preserve the bladder.

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Authors and Affiliations

  1. Klinik und Poliklinik für Urologie, Klinikum rechts der Isar, TU München, München, Deutschland

    M. E. Autenrieth, T. Horn, F. Kurtz, K. Nguyen & J. E. Gschwend

  2. Klinik und Poliklinik für Nuklearmedizin, Klinikum rechts der Isar, TU München, München, Deutschland

    M. Schwaiger, M. Blechert, C. Seidl, R. Senekowitsch-Schmidtke & K. Scheidhauer

  3. Institut für Transurane der Europäischen Kommission, Karlsruhe, Deutschland

    A. Morgenstern & F. Bruchertseifer

Authors
  1. M. E. Autenrieth
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  2. T. Horn
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  3. F. Kurtz
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  4. K. Nguyen
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  5. A. Morgenstern
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  6. F. Bruchertseifer
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  7. M. Schwaiger
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  8. M. Blechert
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  9. C. Seidl
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  10. R. Senekowitsch-Schmidtke
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  11. J. E. Gschwend
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  12. K. Scheidhauer
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Corresponding author

Correspondence to M. E. Autenrieth.

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Interessenkonflikt

M. E. Autenrieth, T. Horn, F. Kurtz, K. Nguyen, A. Morgenstern, F. Bruchertseifer, M. Schwaiger, M. Blechert, C. Seidl, R. Senekowitsch-Schmidtke, J. E. Gschwend und K. Scheidhauer geben an, dass kein Interessenkonflikt besteht.

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

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Autenrieth, M.E., Horn, T., Kurtz, F. et al. Intravesikale Radioimmuntherapie des Carcinoma in situ der Harnblase nach BCG-Versagen. Urologe 56, 40–43 (2017). https://doi.org/10.1007/s00120-016-0273-4

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  • DOI: https://doi.org/10.1007/s00120-016-0273-4

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