Aktuelle Systemtherapie des metastasierten Harnblasenkarzinoms

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Zusammenfassung

Im November 2016 wurden Studiendaten zur Zweitlinientherapie des metastasierten Urothelkarzinoms mit dem PD-1-Antikörper Pembrolizumab publiziert, die einen Vorteil im Gesamtüberleben (OS) gegenüber einer konventionellen Chemotherapie mit Paclitaxel, Docetaxel oder Vinflunin zeigen. Andere PD-1/PD-L1-Inhibitoren werden in Phase-III-Studien für verschiedene Stadien des Urothelkarzinoms geprüft. In Europa wurde am 02.06.2017 mit Nivolumab der erste PD-1-/PD-L1-Antikörper zur Zweitlinientherapie des metastasierten Urothelkarzinoms zugelassen, weitere Zulassungen werden noch in diesem Jahr erwartet. Die Substanzklasse der PD-1-/PD-L1-Inhibitoren dürfte somit der neue Standard in der Zweitlinientherapie des metastasierten Urothelkarzinoms sein. Aktuelle Studien überprüfen den Einsatz von PD-1-/PD-L1-gerichteten Substanzen auch in der Erstlinientherapie des metastasierten Urothelkarzinoms. Dabei werden verschiedene Therapiestrategien verfolgt: Monotherapien mit PD-1-/PD-L1-Inhibitoren sowie deren Kombinationen mit CTLA-4-Inhibitoren oder konventioneller Chemotherapie. Es liegen bereits Daten aus einarmigen Phase-II-Studien zur Monotherapie vor. Erste Daten aus randomisierten Studien werden für Ende 2017 erwartet. Ein neuer Therapieansatz verfolgt den Einsatz von PD-1/PD-L1-Inhibitoren in der perioperativen Behandlung bei Patienten mit einem muskelinvasiven Urothelkarzinom nach chirurgischer R0-Resektion (radikale Zystektomie oder Nephroureterektomie). Zwei internationale Phase-III-Studien überprüfen derzeit eine adjuvante Immuntherapie mit Nivolumab oder Atezolizumab. Die Studienrekrutierung wird voraussichtlich Mitte 2018 beendet sein.

Schlüsselwörter

Urothelkarzinom Immuntherapie PD-1-/PD-L1-Inhibition Chemotherapie Nephroureterektomie 

Current systemic treatment of metastatic bladder cancer

Abstract

In November 2016 results of a phase III clinical trial with the PD-1 inhibitor pembrolizumab for second-line treatment of metastatic urothelial carcinoma were published, which showed an overall survival benefit in comparison with conventional chemotherapy with vinflunine, docetaxel or paclitaxel. Other PD-1/PD-L1 inhibitors are being tested in phase III trials for different stages of urothelial carcinoma. On 2 June 2017 nivolumab was approved in Europe as the first PD-1/PD-L1 inhibitor for the second-line treatment of urothelial carcinoma. Other approvals are expected within this year possibly making this substance class the new standard for second-line treatment of advanced urothelial carcinoma. Currently, PD-1/PD-L1 inhibitors are also being tested for first-line treatment using different approaches either as a monotherapy or in combination with conventional chemotherapy or CTLA-4 inhibitors. Whereas data from single-arm phase II clinical trials have already been published, first phase III data are expected for the end of 2017. A new therapy approach evaluates the use of PD-1/PD-L1 inhibitors for the perioperative treatment of patients with muscle-invasive urothelial carcinoma after complete surgical R0 resection (radical cystectomy or nephroureterectomy). Two international phase III trials on adjuvant immunotherapy with nivolumab and atezolizumab are currently recruiting patients, which is likely to be completed in early 2018.

Keywords

Urothelial carcinoma Immunotherapy PD-1/PD-L1 inhibition Chemotherapy Nephroureterectomy 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

T. Horn, G. von Amsberg, R. Tauber und M. Retz geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Urologische Klinik und Poliklinik, Klinikum rechts der IsarTechnische Universität MünchenMünchenDeutschland
  2. 2.Medizinische Klinik und PoliklinikUniversitätsklinikum Hamburg-EppendorfHamburgDeutschland

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