Pregledni rad
https://doi.org/10.20471/LO.2021.49.02-03.13
First line therapy of metastatic urothelial bladder cancer
Lorena Stamičar
; University of Zagreb School of Medicine, Zagreb, Croatia
Marija Gamulin
; University of Zagreb School of Medicine, Zagreb, Croatia;Department of Oncology, University Hospital Center Zagreb, Zagreb, Croatia
Sažetak
This manuscript reviewes recent knowledge regarding first line therapy of metastatic urothelial bladder cancer. Bladder cancer is on the 10th place in the world by its incidence, and more prevalent in men. Patients with metastatic urothelial cancer should be classified into one of the two groups: cisplatin eligible and cisplatin-ineligible. Cisplatin-eligible can be treated with cisplatin based regimens and have better outcome. Cisplatin-ineligible patients (40-50%) are cisplatin-ineligible patients are primarily those with creatinine clirence les than 50 ml/min, the ones with certain comorbities and/or poor ECOG performance status, and, as an alternative, can be treated with carboplatin which is less effective. After the diagnosis of metastatic bladder cancer has been confirmed, it is necessary to choose one of the cisplatin based chemotherapy regimens. However, one should have in mind that cisplatin can cause certain side effects such as nephrotoxic, neurotoxic and ototoxic effects.
A minority of patients are not eligible for any platinum-containing chemotherapy regimen.
Besides chemotherapy regimens, checkpoint inhibitors (CPIs)-PD-1 and PD-L1 inhibitors play an important role in first-line therapy of metastatic urothelial cancer. NCCN guidelines have included avelumab, pembrolizumab and atezolizumab in a first-line systemic therapy. Recently, Javelin Bladder 100 study has confirmed a positive impact of avelumab as a maitenance therapy in cisplatin-eligible and cisplatin-ineligible patients, which is why the combination of chemotherapy and avelumab is nowadays deemed to be the best therapeutic option.
Ključne riječi
first line therapy; metastatic urothelial bladder cancer; maintenance immunotherapy
Hrčak ID:
267950
URI
Datum izdavanja:
22.12.2021.
Posjeta: 1.416 *