From Clinical Trials to Real-life Clinical Practice: The Role of Immunotherapy with PD-1/PD-L1 Inhibitors in Advanced Urothelial Carcinoma
From Clinical Trials to Real-life Clinical Practice: The Role of Immunotherapy with PD-1/PD-L1 Inhibitors in Advanced Urothelial Carcinoma
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DOI：
10.1016/j.euo.2018.05.011
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发表时间：
2018-12-01
影响因子：
8.2
通讯作者：
Protheroe, Andrew
中科院分区：
文献类型：
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作者：
Hussain, Syed A.;Birtle, Alison;Protheroe, Andrew
内容：根据多项临床试验的结果，最近有许多PD-1/PD-L1抑制剂被批准用于治疗局部晚期或转移性尿路上皮癌（UC）患者。目的：回顾这些试验的证据，并考虑这些药物在一线和铂类后临床实践中的应用意义。证据获取：在PubMed中检索了PD-1/D-L1抑制剂单药治疗晚期UC临床试验的完整报告。证据综合：PD-1/PD-L1抑制剂的反应似乎是持久的，但仅在17-26%的患者中实现。这些药物提供了不同的毒性和疗效的标准化疗方案。这应该考虑到为每个patient.Conclusions选择治疗策略时：PD-1/PD-L1抑制剂代表了一个重大的进步，在管理晚期UC，虽然几个问题仍然关于其最佳使用在常规临床实践。一个有效的预测生物标志物的反应尚未被定义，这可能是目前可用的drugs.Patient摘要最显着未满足的需求：我们回顾了临床试验的结果，调查如何以及某些类型的抗癌药物称为PD-1/PD-L1抑制剂在膀胱癌患者的工作。我们发现，需要更多的研究来确定（1）可能预测哪些膀胱癌患者对PD-1/PD-L1抑制剂有反应的因素，以及（2）这些药物的最佳治疗持续时间。(C)2018作者（S）由Elsevier B. V.代表欧洲泌尿外科协会发布。
Context: A number of PD-1/PD-L1 inhibitors have recently been approved for use in patients with locally advanced or metastatic urothelial carcinoma (UC) on the basis of results from several clinical trials.Objective: To review the evidence from these trials and consider what it means for the use of these drugs in first-line and post-platinum settings in real-life clinical practice.Evidence acquisition: PubMed was searched for full reports of clinical trials of single-agent PD-1/D-L1 inhibitors in advanced UC. Twelve publications were included.Evidence synthesis: Responses to PD-1/PD-L1 inhibitors appear to be durable but are only achieved in 17-26% of patients. These drugs offer different toxicity and efficacy profiles to standard chemotherapy regimens. This should be considered when choosing a treatment strategy for each patient.Conclusions: PD-1/PD-L1 inhibitors represent a major step forward in the management of advanced UC, although several questions remain regarding their optimal use in routine clinical practice. A validated predictive biomarker of response is yet to be defined, and this is perhaps the most significant unmet need for currently available drugs.Patient summary: We reviewed the results from clinical trials that investigated how well certain types of anticancer drugs called PD-1/PD-L1 inhibitors worked in patients with bladder cancer. We found that more research is required to identify (1) the factors that might predict which patients with bladder cancer will respond to PD-1/PD-L1 inhibitors and (2) the optimum duration of treatment with these drugs. (C) 2018 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology.