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„Surgery only“ reicht nicht aus: Potenziale einer multimodalen Therapie beim Urothelkarzinom der Harnblase

“Surgery only” is not enough: potential of multimodal therapy in urothelial bladder carcinoma

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Zusammenfassung

Die radikale Blasentfernung ist die Standardtherapie beim muskelinvasiven Blasenkarzinom. Der Einsatz einer begleitenden, Cisplatin-haltigen Chemotherapie führt zu einer signifikanten Verbesserung des Gesamtüberlebens. Durch eine neoadjuvante Therapie steigt die 5‑Jahres-Gesamtüberlebensrate um 5 % im Vergleich zur alleinigen Lokaltherapie. Auf dieser Basis wurden verschiedene neuere, multimodale Therapiekonzepte entwickelt. Ein Teil dieser Konzepte strebt – wie bei der trimodalen Therapie – den Blasenerhalt an, um die mit der Zystektomie verbundene Morbidität zu verringern. Andere Konzepte – wie die neuen perioperativen Ansätze mit Checkpoint-Inhibitoren – werden entwickelt, um die onkologische Effektivität zu verbessern. Hier haben sich in der letzten Zeit interessante neue Entwicklungen ergeben, beispielsweise in der Radioimmuntherapie und in der perioperativen Kombinationstherapie. Diese sollen hier zusammen mit den Standardtherapien beleuchtet werden.

Abstract

Radical cystectomy is the standard treatment for muscle invasive bladder cancer. Using perioperative cisplatin-based chemotherapy, 5‑year overall survival rates are 5% higher with neoadjuvant chemotherapy compared to local therapy alone. New multimodal concepts have been developed to improve oncologic efficacy and to reduce treatment-related morbidity. Perioperative use of checkpoint inhibitors aims at improving efficacy, while bladder-preserving concepts try to avoid cystectomy in good responders. This article reviews new developments in radioimmunotherapy and perioperative combination therapies as well as bladder-preserving concepts like trimodal bladder therapy.

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Authors and Affiliations

  1. Klinik und Poliklinik für Urologie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland

    S. C. Schmid, J. Lewerich & M. Retz

  2. Klinik für Strahlentherapie und Onkologie, Universitätsklinikum der Goethe-Universität Frankfurt, Frankfurt, Deutschland

    Claus Rödel

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  1. S. C. Schmid
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  2. J. Lewerich
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  4. Claus Rödel
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Correspondence to S. C. Schmid.

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Interessenkonflikt

S.C. Schmid: Studienleitung der RACE-IT-Studie (Funding Bristol-Myers Squibb). Honoraria/Reisekostenerstattung: Astellas, Bristol-Myers Squibb, Ipsen, Janssen-Cilag, Novartis. J. Lewerich: Honoraria/Reisekostenerstattung: Merck. M. Retz: stellvertretende Studienleitung der RACE IT Studie (Funding Bristol-Myers Squibb). Referententätigkeit: Astellas, AstraZeneca, Bayer, Bristol-Myers-Squibb, Janssen-Cilag, Merck, MSD, Pfizer, Roche; Beratende Funktion: Astellas, AstraZeneca, Bristol-Myers-Squibb, Gilead, Janssen-Cilag, Merck, MSD, Pfizer, Roche. C. Rödel gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Schmid, S.C., Lewerich, J., Retz, M. et al. „Surgery only“ reicht nicht aus: Potenziale einer multimodalen Therapie beim Urothelkarzinom der Harnblase. Urologie 61, 1332–1340 (2022). https://doi.org/10.1007/s00120-022-01963-9

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