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22.11.2022 | Originalien

Das metastasierte Urothelkarzinom – leitlinienorientierte Therapie und neue Optionen

verfasst von: Univ.-Prof. Dr. med. Günter Niegisch, Gunhild von Amsberg, Marc Rehlinghaus, Camilla M. Grunewald, Margitta Retz

Erschienen in: Journal für Urologie und Urogynäkologie/Österreich

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Zusammenfassung

Durch die Zulassung immunonkologischer Therapien mit Immun-Checkpoint-Inhibitoren ist die Behandlung des metastasierten Urothelkarzinoms in allen Therapielinien komplexer geworden. So finden sich mittlerweile in der Erstlinientherapie neben der alleinigen klassischen Behandlung mit Platin-basierten Kombinationschemotherapien sowohl die Option einer alleinigen Immuntherapie als auch einer Immunerhaltungstherapie im Anschluss an die Chemotherapie. Bei der Therapiewahl sind neben dem Zulassungsstatus und der Leitlinienempfehlung immer auch patientenindividuelle Faktoren wie Komorbiditäten sowie die Patientenpräferenz zu berücksichtigen. Der folgende Artikel soll die aktuelle Datenlage zu verschiedenen Behandlungsoptionen in der Erstlinientherapie des metastasierten Urothelkarzinoms zusammenfassen und diese anhand eines Patientenbeispiels illustrieren.
Literatur
2.
Zurück zum Zitat Bajorin DF et al (1999) Long-term survival in metastatic transitional-cell carcinoma and prognostic factors predicting outcome of therapy. J Clin Oncol 17(10):3173–3181 CrossRefPubMed Bajorin DF et al (1999) Long-term survival in metastatic transitional-cell carcinoma and prognostic factors predicting outcome of therapy. J Clin Oncol 17(10):3173–3181 CrossRefPubMed
3.
Zurück zum Zitat Bellmunt J et al (2002) Pretreatment prognostic factors for survival in patients with advanced urothelial tumors treated in a phase I/II trial with paclitaxel, cisplatin, and gemcitabine. Cancer 95(4):751–757 CrossRefPubMed Bellmunt J et al (2002) Pretreatment prognostic factors for survival in patients with advanced urothelial tumors treated in a phase I/II trial with paclitaxel, cisplatin, and gemcitabine. Cancer 95(4):751–757 CrossRefPubMed
4.
Zurück zum Zitat De Santis M et al (2012) Randomized phase II/III trial assessing gemcitabine/carboplatin and methotrexate/carboplatin/vinblastine in patients with advanced urothelial cancer who are unfit for cisplatin-based chemotherapy: EORTC study 30986. J Clin Oncol 30(2):191–199 CrossRefPubMed De Santis M et al (2012) Randomized phase II/III trial assessing gemcitabine/carboplatin and methotrexate/carboplatin/vinblastine in patients with advanced urothelial cancer who are unfit for cisplatin-based chemotherapy: EORTC study 30986. J Clin Oncol 30(2):191–199 CrossRefPubMed
5.
Zurück zum Zitat Galsky MD et al (2011) Treatment of patients with metastatic urothelial cancer “unfit” for cisplatin-based chemotherapy. J Clin Oncol 29(17):2432–2438 CrossRefPubMed Galsky MD et al (2011) Treatment of patients with metastatic urothelial cancer “unfit” for cisplatin-based chemotherapy. J Clin Oncol 29(17):2432–2438 CrossRefPubMed
6.
Zurück zum Zitat Balar AV et al (2017) First-line pembrolizumab in cisplatin-ineligible patients with locally advanced and unresectable or metastatic urothelial cancer (KEYNOTE-052): a multicentre, single-arm, phase 2 study. Lancet Oncol 18(11):1483–1492 CrossRefPubMed Balar AV et al (2017) First-line pembrolizumab in cisplatin-ineligible patients with locally advanced and unresectable or metastatic urothelial cancer (KEYNOTE-052): a multicentre, single-arm, phase 2 study. Lancet Oncol 18(11):1483–1492 CrossRefPubMed
7.
Zurück zum Zitat Balar AV et al (2017) Atezolizumab as first-line treatment in cisplatin-ineligible patients with locally advanced and metastatic urothelial carcinoma: a single-arm, multicentre, phase 2 trial. Lancet 389(10064):67–76 CrossRefPubMed Balar AV et al (2017) Atezolizumab as first-line treatment in cisplatin-ineligible patients with locally advanced and metastatic urothelial carcinoma: a single-arm, multicentre, phase 2 trial. Lancet 389(10064):67–76 CrossRefPubMed
8.
Zurück zum Zitat Kardoust Parizi M et al (2021) Fibroblast growth factor receptor: a systematic review and meta-analysis of prognostic value and therapeutic options in patients with urothelial bladder carcinoma. Urol Oncol 39(7):409–421 CrossRefPubMed Kardoust Parizi M et al (2021) Fibroblast growth factor receptor: a systematic review and meta-analysis of prognostic value and therapeutic options in patients with urothelial bladder carcinoma. Urol Oncol 39(7):409–421 CrossRefPubMed
9.
Zurück zum Zitat Siefker-Radtke AO et al (2018) First results from the primary analysis population of the phase 2 study of erdafitinib (ERDA; JNJ-42756493) in patients (pts) with metastatic or unresectable urothelial carcinoma (mUC) and FGFR alterations (FGFRalt). J Clin Oncol 36(15_suppl):4503–4503 CrossRef Siefker-Radtke AO et al (2018) First results from the primary analysis population of the phase 2 study of erdafitinib (ERDA; JNJ-42756493) in patients (pts) with metastatic or unresectable urothelial carcinoma (mUC) and FGFR alterations (FGFRalt). J Clin Oncol 36(15_suppl):4503–4503 CrossRef
10.
Zurück zum Zitat Sternberg CN 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(10):2638–2646 CrossRefPubMed Sternberg CN 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(10):2638–2646 CrossRefPubMed
11.
Zurück zum Zitat von der Maase H et al (2000) Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol 18(17):3068–3077 CrossRefPubMed von der Maase H et al (2000) Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol 18(17):3068–3077 CrossRefPubMed
12.
Zurück zum Zitat Niegisch G et al (2018) A real-world data study to evaluate treatment patterns, clinical characteristics and survival outcomes for first- and second-line treatment in locally advanced and metastatic urothelial cancer patients in Germany. J Cancer 9(8):1337–1348 CrossRefPubMedPubMedCentral Niegisch G et al (2018) A real-world data study to evaluate treatment patterns, clinical characteristics and survival outcomes for first- and second-line treatment in locally advanced and metastatic urothelial cancer patients in Germany. J Cancer 9(8):1337–1348 CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat Dash A et al (2006) Impact of renal impairment on eligibility for adjuvant cisplatin-based chemotherapy in patients with urothelial carcinoma of the bladder. Cancer 107(3):506–513 CrossRefPubMed Dash A et al (2006) Impact of renal impairment on eligibility for adjuvant cisplatin-based chemotherapy in patients with urothelial carcinoma of the bladder. Cancer 107(3):506–513 CrossRefPubMed
14.
Zurück zum Zitat Balducci L, Yates J (2000) General guidelines for the management of older patients with cancer. Oncology 14(11A):221–227 PubMed Balducci L, Yates J (2000) General guidelines for the management of older patients with cancer. Oncology 14(11A):221–227 PubMed
15.
Zurück zum Zitat De Santis M et al (2016) Vinflunine-gemcitabine versus vinflunine-carboplatin as first-line chemotherapy in cisplatin-unfit patients with advanced urothelial carcinoma: results of an international randomized phase II trial (JASINT1). Ann Oncol 27(3):449–454 CrossRefPubMed De Santis M et al (2016) Vinflunine-gemcitabine versus vinflunine-carboplatin as first-line chemotherapy in cisplatin-unfit patients with advanced urothelial carcinoma: results of an international randomized phase II trial (JASINT1). Ann Oncol 27(3):449–454 CrossRefPubMed
16.
Zurück zum Zitat Culine S et al (2011) Gemcitabine or gemcitabine plus oxaliplatin in the first-line treatment of patients with advanced transitional cell carcinoma of the urothelium unfit for cisplatin-based chemotherapy: a randomized phase 2 study of the French Genitourinary Tumor Group (GETUG V01). Eur Urol 60(6):1251–1257 CrossRefPubMed Culine S et al (2011) Gemcitabine or gemcitabine plus oxaliplatin in the first-line treatment of patients with advanced transitional cell carcinoma of the urothelium unfit for cisplatin-based chemotherapy: a randomized phase 2 study of the French Genitourinary Tumor Group (GETUG V01). Eur Urol 60(6):1251–1257 CrossRefPubMed
17.
Zurück zum Zitat Koshkin VS et al (2018) Feasibility of cisplatin-based neoadjuvant chemotherapy in muscle-invasive bladder cancer patients with diminished renal function. Clin Genitourin Cancer 16(4):e879–e892 CrossRefPubMed Koshkin VS et al (2018) Feasibility of cisplatin-based neoadjuvant chemotherapy in muscle-invasive bladder cancer patients with diminished renal function. Clin Genitourin Cancer 16(4):e879–e892 CrossRefPubMed
18.
Zurück zum Zitat Castagneto B et al (2004) Single-agent gemcitabine in previously untreated elderly patients with advanced bladder carcinoma: response to treatment and correlation with the comprehensive geriatric assessment. Oncology 67(1):27–32 CrossRefPubMed Castagneto B et al (2004) Single-agent gemcitabine in previously untreated elderly patients with advanced bladder carcinoma: response to treatment and correlation with the comprehensive geriatric assessment. Oncology 67(1):27–32 CrossRefPubMed
19.
Zurück zum Zitat Galsky MD et al (2020) Atezolizumab with or without chemotherapy in metastatic urothelial cancer (IMvigor130): a multicentre, randomised, placebo-controlled phase 3 trial. Lancet 395(10236):1547–1557 CrossRefPubMed Galsky MD et al (2020) Atezolizumab with or without chemotherapy in metastatic urothelial cancer (IMvigor130): a multicentre, randomised, placebo-controlled phase 3 trial. Lancet 395(10236):1547–1557 CrossRefPubMed
20.
Zurück zum Zitat Powles T et al (2021) Pembrolizumab alone or combined with chemotherapy versus chemotherapy as first-line therapy for advanced urothelial carcinoma (KEYNOTE-361): a randomised, open-label, phase 3 trial. Lancet Oncol 22(7):931–945 CrossRefPubMed Powles T et al (2021) Pembrolizumab alone or combined with chemotherapy versus chemotherapy as first-line therapy for advanced urothelial carcinoma (KEYNOTE-361): a randomised, open-label, phase 3 trial. Lancet Oncol 22(7):931–945 CrossRefPubMed
21.
Zurück zum Zitat Galsky MD et al (2021) A phase III, randomized, open-label, multicenter, global study of first-line durvalumab plus standard of care (SoC) chemotherapy and durvalumab plus tremelimumab, and SoC chemotherapy versus SoC chemotherapy alone in unresectable locally advanced or metastatic urothelial cancer (NILE). J Clin Oncol 39(6_suppl):TPS504 CrossRef Galsky MD et al (2021) A phase III, randomized, open-label, multicenter, global study of first-line durvalumab plus standard of care (SoC) chemotherapy and durvalumab plus tremelimumab, and SoC chemotherapy versus SoC chemotherapy alone in unresectable locally advanced or metastatic urothelial cancer (NILE). J Clin Oncol 39(6_suppl):TPS504 CrossRef
22.
Zurück zum Zitat Powles T et al (2020) Avelumab maintenance therapy for advanced or metastatic urothelial carcinoma. N Engl J Med 383(13):1218–1230 CrossRefPubMed Powles T et al (2020) Avelumab maintenance therapy for advanced or metastatic urothelial carcinoma. N Engl J Med 383(13):1218–1230 CrossRefPubMed
Metadaten
Titel
Das metastasierte Urothelkarzinom – leitlinienorientierte Therapie und neue Optionen
verfasst von
Univ.-Prof. Dr. med. Günter Niegisch
Gunhild von Amsberg
Marc Rehlinghaus
Camilla M. Grunewald
Margitta Retz
Publikationsdatum
22.11.2022
Verlag
Springer Vienna
Erschienen in
Journal für Urologie und Urogynäkologie/Österreich
Print ISSN: 1023-6090
Elektronische ISSN: 1680-9424
DOI
https://doi.org/10.1007/s41972-022-00181-x