Treatment of muscle-invasive and advanced bladder cancer in 2020
Treatment of muscle-invasive and advanced bladder cancer in 2020
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DOI：
10.3322/caac.21631
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发表时间：
2020-08-07
影响因子：
254.7
通讯作者：
Galsky, Matthew D.
中科院分区：
文献类型：
--
作者：
Patel, Vaibhav G.;Oh, William K.;Galsky, Matthew D.
全世界每年有近17万人死于膀胱癌。40多年来，肌肉侵袭性晚期膀胱癌的系统治疗主要由铂类化疗组成。在过去的10年里，测序技术的创新导致了膀胱癌的快速基因组表征，加深了我们对膀胱癌发病机制的理解，并暴露了潜在的治疗脆弱性。基于其高突变负担，免疫检查点抑制剂在晚期膀胱癌中进行了研究，揭示了部分患者的持久反应。这些药物现在被批准用于几种适应症，并突出了晚期膀胱癌治疗前景的变化。此外，通常表达的分子靶点被用于开发靶向治疗，如成纤维细胞生长因子受体抑制剂和抗体-药物偶联物。膀胱癌的分子特征和新疗法的发展也刺激了对肌肉浸润性膀胱癌治疗方法的优化研究。在此，作者回顾了肌肉侵袭性和晚期膀胱癌的治疗历史，强调了膀胱癌的重要分子特征，描述了治疗的主要进展，并提出了未来治疗发展的方向。
Bladder cancer accounts for nearly 170,000 deaths worldwide annually. For over 4 decades, the systemic management of muscle-invasive and advanced bladder cancer has primarily consisted of platinum-based chemotherapy. Over the past 10 years, innovations in sequencing technologies have led to rapid genomic characterization of bladder cancer, deepening our understanding of bladder cancer pathogenesis and exposing potential therapeutic vulnerabilities. On the basis of its high mutational burden, immune checkpoint inhibitors were investigated in advanced bladder cancer, revealing durable responses in a subset of patients. These agents are now approved for several indications and highlight the changing treatment landscape of advanced bladder cancer. In addition, commonly expressed molecular targets were leveraged to develop targeted therapies, such as fibroblast growth factor receptor inhibitors and antibody-drug conjugates. The molecular characterization of bladder cancer and the development of novel therapies also have stimulated investigations into optimizing treatment approaches for muscle-invasive bladder cancer. Herein, the authors review the history of muscle-invasive and advanced bladder cancer management, highlight the important molecular characteristics of bladder cancer, describe the major advances in treatment, and offer future directions for therapeutic development.