利用免疫检查点抑制剂进行肌层侵袭性膀胱癌的保留膀胱治疗。
Bladder-sparing treatment for muscle-invasive bladder carcinoma using immune checkpoint inhibitors.
发表日期：2023 Sep 15
作者：
Chao Xu, Wen Zou, Yinhuai Wang, Xianling Liu, Jingjing Wang
来源：
CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY
摘要：
多模式膀胱保留疗法已成为肌层浸润性膀胱癌（MIBC）患者中那些不能或不愿进行全膀胱切除术的替代方法。已经对采用免疫检查点抑制剂（ICI）的多种膀胱保留策略进行了研究。ICI为基础的膀胱保留疗法有三种常见模式，其中最研究的是ICI与化学放疗的联合应用。ICI与放疗的膀胱保留策略已在对化疗耐受性差的患者中进行了研究。ICI与化疗的联合应用也已在对新辅助治疗有临床完全缓解的患者中进行了探索。所有上述策略显示出有希望的疗效和可管理的安全性概况。但是，用于预测免疫基础膀胱保留疗法疗效的程序性死亡配体1（PD-L1）表达、肿瘤突变负荷和基因改变的价值仍然存在争议。免疫基础膀胱保留疗法仍然面临一些挑战，需要大样本随机试验来验证。版权所有 © 2023. Elsevier B.V. 发表。
Multimodal bladder preservation therapy is already an alternative for patients with muscle-invasive bladder cancer (MIBC) who are unable or unwilling to undergo radical cystectomy. Various bladder-preserving strategies that employ immune checkpoint inhibitors (ICIs) for MIBC have been investigated. There are three common modes of ICI-based bladder preservation therapy, of which the most studied is ICIs combined with chemoradiotherapy. The bladder-preserving strategy of ICIs combined with radiation has been investigated in patients who poorly tolerate chemotherapy. ICIs combined with chemotherapy have also been explored in patients who responded to neoadjuvant therapy with a clinical complete response. All the above-described strategies have shown promising efficacy and manageable safety profiles. However, the value of programmed death-ligand 1 (PD-L1) expression, tumor mutation burden and gene alterations for predicting the efficacy of immune-based bladder preservation therapy is still controversial. There remain some challenges for immune-based bladder preservation therapy, and large-sample randomized trials are needed.Copyright © 2023. Published by Elsevier B.V.