医学
化疗
肿瘤科
转移性尿路上皮癌
顺铂
临床试验
膀胱癌
内科学
癌症
药物开发
人口
药品
药理学
尿路上皮癌
环境卫生
作者
Andreia Bilé-Silva,Antonio López-Beltrán,Ana Blanca,Fernando López-Rı́os,Enrique Gómez‐Gómez,Alessia Cimadamore,Rodolfo Montironi,Nuno Vau,Cheng Liu
标识
DOI:10.1080/14712598.2023.2201371
摘要
Cisplatin-based chemotherapy is currently considered the gold-standard treatment for metastatic urothelial carcinoma (mUC). Nevertheless, most mUC patients develop resistance to chemotherapy. Immune checkpoint inhibitors (ICI) have emerged as a therapeutic option for mUC. ICI are used as both first- and second-line therapy for patients with mUC but also for maintenance following chemotherapy and durable responses may be expected in these settings.Patients with mUC who experience progression after platinum-based chemotherapy regimens, those who are cisplatin-ineligible and have positive PD-L1 expression, and those who are platinum-ineligible, regardless of PD-L1 status, are the target population. The role of ICI monotherapy or drug combinations and newer proposals for mUC therapy are reviewed. The current status of biomarkers to guide ICI treatments in mUC is also provided, focusing on PD-L1, tumor mutational load, and liquid biopsies using ctDNA.Current challenges to improve the role of ICI in mUC could be summarized as i) development of better drugs; ii) advances in drug-combinations schemes; iii) development of novel biomarkers and techniques to better select patients for this treatment; iv) providing the drugs in the optimal clinical setting; v) promoting trials covering more demographic and clinical heterogeneity (i.e. wider age range, gender, and diverse clinical representation).
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