晚期膀胱癌的化疗进展

在过去十几年中MVAC方案一直是晚期膀胱癌的传统标准化疗方案 ,随着近年来许多新化疗药物的广泛使用 ,许多以新药为主的联合化疗方案的疗效令人鼓舞 ,吉西他滨与顺铂联合化疗方案 (GC方案 )已经取代MVAC方案成为新的标准化疗方案。     

晚期膀胱癌的化疗进展

在过去十几年中MVAC方案一直是晚期膀胱癌的传统标准化疗方案，随着近年来许多新化疗药物的广泛使用，许多以新药为主的联合化疗方案的疗效令人鼓舞，吉西他滨与顺铂联合化疗方案(GC方案)已经取代MVAC方案成为新的标准化疗方案。     

晚期膀胱癌的临床治疗进展

膀胱癌是泌尿系统最常见的恶性肿瘤之一,近年来其发病率在全世界范围内呈上升趋势,晚期膀胱癌的治疗仍然是世界性难题,手术治疗、放疗、化疗、介入治疗等各有作用.本文就晚期膀胱癌的治疗进展进行综述.     

膀胱癌流行病学进展

据美国癌症协会统计,2006年在美国,膀胱癌在男性是继前列腺癌、肺癌和直肠癌以后排名第四位的恶性肿瘤,在女性排名第九位。大约有6万余人被临床医生诊断为膀胱癌,每年有1万余人死于膀胱癌[1]。流行病学和实验上证据显示膀胱癌的发病与一些致癌因素有关,但很多病例不伴有明显的与已知致癌因素的接触。同样的,当临床医生诊断和治疗膀胱癌时,很少认识到一些因素对发病率、诊断和生存率的影响,这些因素包括年龄、性别、人种等。随着欧美对膀胱癌人群的分析增多,年龄、性别、人种及一些致癌因素对膀胱癌的影响逐渐被报道,本文就当前该领域的论述进行综述。     

膀胱癌免疫治疗进展

膀胱癌是秘尿外科员常见的恶性肿瘤，在美国占肿窟发病率的第4位。手术治疗是膀胱癌的最佳治疗方案，术后使用抗肿瘤药物可以预防复发；但是，效果还不够理想。随着免疫学的发展，为了提高疗效，国外学者将肿窟免疫学应用于治疗和预防膀胱肿瘤，如：BCG、TIL、杆菌壁提取物等。     

膀胱癌免疫治疗进展

膀胱癌是泌尿外科最常见的恶性肿瘤 ,在美国占肿瘤发病率的第 4位。手术治疗是膀胱癌的最佳治疗方案 ,术后使用抗肿瘤药物可以预防复发 ;但是 ,效果还不够理想。随着免疫学的发展 ,为了提高疗效 ,国外学者将肿瘤免疫学应用于治疗和预防膀胱肿瘤 ,如 :BCG、TIL、杆菌壁提取物等     

吉西他滨治疗膀胱癌的进展

目前吉西他滨已广泛应用于膀胱癌的治疗，近来以其为基础的联合化疗更是屡有报道，本文就吉西他滨治疗膀胱癌的有效性和安全性作一综述。     

吉西他滨治疗膀胱癌的进展

目前吉西他滨已广泛应用于膀胱癌的治疗 ,近来以其为基础的联合化疗更是屡有报道 ,本文就吉西他滨治疗膀胱癌的有效性和安全性作一综述     

Update on chemotherapy for advanced bladder cancer

PURPOSE: Recent years have seen several advances in the treatment of locally advanced and metastatic bladder cancer. We summarize the current state of the art for advanced bladder cancer treatment. MATERIALS AND METHODS: A comprehensive review of published, prospective phase II/III clinical trials and retrospective analyses of patients with advanced bladder cancer was performed. RESULTS: Adjuvant and neoadjuvant chemotherapeutic strategies around the time of radical cystectomy have been used to decrease the risk of subsequent metastatic disease. Although the benefit of adjuvant chemotherapy remains unproven, neoadjuvant chemotherapy is associated with a modest 5% to 6% absolute survival benefit in 2 meta-analyses of the available data. Chemoradiation is feasible and effective in some patients, allowing bladder preservation with an acceptable risk of progression. Randomized, phase III data comparing methotrexate, vinblastine, doxorubicin and cisplatin chemotherapy to gemcitabine/cisplatin showed similar response proportions and overall survival with less toxicity in the gemcitabine/cisplatin arm. This has led to the widespread use of gemcitabine/cisplatin as first line chemotherapy for metastatic bladder cancer. The optimal agents and regimens for second line chemotherapy remain undefined. Similarly biological and targeted therapies for advanced bladder cancer remain investigational. CONCLUSIONS: Combination cisplatin based neoadjuvant chemotherapy may benefit patients with locally advanced bladder cancer. Gemcitabine/cisplatin has replaced methotrexate, vinblastine, doxorubicin and cisplatin as the regimen of choice in patients with good renal function. The optimal regimens for the medically unfit patient and second line chemotherapy remain undefined. The development of targeted therapies, less toxic regimens and improved cytotoxic agents are necessary to improve outcomes.     

Combination chemotherapy for advanced bladder cancer

Adriamycin, bleomycin, 5-fluorouracil and methotrexate have been used in combination in a Phase II study and as adjuvant chemotherapy for patients with locally advanced bladder cancer. Although early results with metastatic disease showed considerable antitumour activity, longer follow-up has shown this drug combination to be ineffective.     

Intra-arterial chemotherapy for locally advanced bladder cancer

A total of 83 patients with locally advanced bladder cancer (T1, n = 5; T2, n = 28; T3a, n = 21; T3b, n = 21; T4, n = 8) were treated with intra-arterial (i.a.) cisplatin and adriamycin (or epirubicin) chemotherapy. In 51 of the 83 cases, we combined this treatment with radiotherapy. The pathological complete response (CR) rate was 68% for all patients, 84% for i.a. chemotherapy combined with radiotherapy and only 41% for i.a. chemotherapy. The 5-year survival rate was 57% for all patients, 71% for i.a. chemotherapy combined with radiotherapy and only 44% for i.a. chemotherapy. The 5-year survival as a function of the clinical stage was 82% for T1 + T2, 66% for T3a, 28% for T3b, 25% for T4 (T1 + T2 vs: T3b: p < 0.001, T1 + T2 vs. T4: p < 0.0001, T3a vs. T3b: p < 0.0263, T3a vs. T4: p < 0.0214, T3b vs. T4: p < 0.029). In 46% of all patients, we succeeded in preserving the bladder; especially noteworthy, is that in 65% of the patients undergoing i.a. chemotherapy combined with radiotherapy, we succeeded in preserving the bladder. These results demonstrate that i.a. chemotherapy combined with radiotherapy is a useful method for locally advanced bladder cancer which may make preservation of the bladder function feasible.     

Adjuvant chemotherapy for locally advanced bladder cancer

Summary Although controversy over the relative efficacy of full-dose pelvic radiation and radical cystectomy, with or without pre-operative radiation, continues, none of these treatments directed only at the disease in the pelvis cures more than 50 percent of patients with locally advanced disease. An effective systemic therapy is needed. The most effective single agent in metastatic bladder cancer, Cis-platin, has not altered the cure rate when used as an adjuvant. Limited trials using Cis-platin based three and four drug combination chemotherapy regimens have yielded 50–70 percent overall response rates with 30 percent complete responses in metastatic disease. It seems appropriate to perform pilot studies using these more intensive programs as adjuvant chemotherapy for good performance status patients at high risk of progression, e.g. positive lymph nodes.Supported by PHS Grant CA15934 awarded by the National Cancer Institute and the Veterans Administration Medical Research Service     

New chemotherapy combinations for advanced bladder cancer

Transitional cell carcinoma of the urothelium is considered a chemosensitive malignancy. Until recently, the methotrexate, vinblastine, doxorubicin and cisplatin combination has been considered the standard for treating this disease. The development of new chemotherapeutic agents such as gemcitabine and the taxanes has opened up promising new perspectives in the treatment of this disease. However, the preliminary phase II data must be confirmed in adequately conducted phase III trials.     

Combination chemotherapy of advanced bladder cancer

Patients with carcinoma of the urinary bladder have a poor prognosis. When distant metastasis develops, such patients seldom survive for more than several months. For them, surgery and/or radiotherapy are of little value, and systemic chemotherapy has been thought to be the most useful treatment. Forty-six patients with advanced transitional cell carcinoma, including bladder cancer, (33 bladder, 9 ureter, 4 renal pelvis cases) were treated by a three drug combination chemotherapy, using two protocols (protocol I: adriamycin + cyclophosphamide + 5-fluorouracil, protocol II: adriamycin + cyclophosphamide + cis-platinum). Protocol I induced responses in 5 of the 24 patients (21%, 1 complete response, 4 partial responses), and protocol II in 7 of the 22 patients (32%, 1 complete response, 6 partial responses). The overall response rate was 26%. The durations of response (median duration 5.1 months) and of survival (median duration 11.3 months) in all responders were relatively short. The three-combination chemotherapy, especially protocol II, was effective against transitional cell carcinoma of the urinary tract, but the results were not satisfactory.     

Chemotherapy for advanced bladder cancer: clinical evaluation of chemotherapy for locally advanced or metastatic bladder cancer and adjuvant chemotherapy for deeply invasive bladder cancer following radical cystectomy

Sixteen patients with locally advanced or metastatic bladder cancer were treated with cis-diamminedichloroplatinum (cis-DDP) alone or in combination with other drugs. Eight patients were given cis-DDP intravenously, 6 patients intraarterially and 2 by both methods. Seven patients (44%) showed a partial response, 2 showed a minor response and 4 remained unchanged. Of the 6 patients treated with arterial infusion, 3 achieved a partial response while only 2 of the 8 patients administered intravenously showed a partial response. Eight patients with deeply invasive bladder cancer were treated with cis-DDP alone or in combination with other drugs following radical cystectomy. Cis-DDP was administered every week for 3 courses and every month for 12 courses at a dose of 50 mg and cis-DDP, adriamycin and 5-FU (CAF) were administered at 3 weeks interval for 3 courses and every month for 12 courses. All patients in this group were alive with a median survival of 20 months. One patient had a recurrence 5 months postoperatively. Adjuvant chemotherapy with cis-DDP or their combination was effective. Toxicity was generally tolerable.     

Concurrent platinum-based chemotherapy and radiotherapy for locally advanced bladder cancer

Eight patients with locally advanced bladder cancer who were not candidates for radical cystectomy or concurrent intra-arterial chemotherapy and radiotherapy were treated with combined platinum-based chemotherapy and radiation therapy. Six of the eight patients (75%) achieved a clinical complete response (CR). The effect of therapy in four patients whose histopathological responses were evaluated was effect grade 3. One of the eight patients died of treatment-related myelosuppression. The other two patients died of intercurrent disease, while the remaining five patients are alive with preservation of a functional bladder. The 2-year overall survival rate was 87.5%. Adverse events due to chemotherapy were mainly bone marrow suppression. Those caused by radiation therapy were rectal irritability. We considered concurrent platinum-based chemotherapy and radiotherapy useful for the treatment of locally advanced bladder cancer.     

The role of adjuvant chemotherapy for locally advanced bladder cancer

The incidence of locally advanced bladder cancer is estimated at 5 new cases per 100,000 of the population annually in North America and most European countries. Radical cystectomy for muscle-invasive organ-confined tumors and locally advanced disease, which is defined as extravesical tumor growth or involvement of regional lymph nodes, is the preferred treatment in Japan, the United States, and in some countries of Europe. The clinical outcome of radical cystectomy has improved remarkably over the past 20 years as a result of advances in operative technique and perioperative care. Nevertheless, at least 50% of patients with invasive bladder cancer are expected to develop progressive disease within the first 2?years when treated with radical cystectomy alone. In order to improve the fate of muscle-invasive and locally advanced disease, the administration of additional therapy to definite treatment has been studied in various forms, such as neoadjuvant and adjuvant systemic chemotherapy as well as combined radio-chemotherapy. Prolonged progression-free survival for patients suffering from locally advanced bladder cancer by administration of adjuvant systemic chemotherapy has been suggested by three randomized studies, published by Skinner, Freiha and Stöckle since 1991. These studies demonstrated a disease-free survival benefit of 17–50% within the first 3–5?years when applying adjuvant systemic chemotherapy after radical cystectomy. Patients who most likely benefit from adjuvant chemotherapy are those with limited node-positive disease, extravesical tumor, and direct invasion into adjacent viscera, such as prostate, uterus, or vagina. This review will summarize past, current, and future aspects of systemic adjuvant chemotherapy for transitional cell carcinoma of the bladder.