PDF(Pubmed)
Abstract：
The treatment landscape for patients with advanced urothelial carcinoma continues to evolve. Enfortumab vedotin plus pembrolizumab has received Food and Drug Administration approval based on recent phase 3 trial data showing superior efficacy compared with first-line platinum-based chemotherapy; however, its distinct toxicity profile may make it less suitable for some patients, and availability in some countries may be limited by cost considerations. Consequently, platinum-based chemotherapy is expected to remain an important first-line treatment option. Choice of platinum regimen (cisplatin- or carboplatin-based) is informed by assessment of clinical characteristics, including performance status, kidney function, and presence of peripheral neuropathy or heart failure. For patients without disease progression after completing platinum-based chemotherapy, avelumab first-line maintenance treatment is recommended by international guidelines. For patients who have disease progression, pembrolizumab is the preferred approach. Additionally, following results from a recent phase 3 trial, nivolumab plus cisplatin-based chemotherapy has also received Food and Drug Administration approval and is an additional first-line treatment option for cisplatin-eligible patients. Later-line options for patients with advanced urothelial carcinoma, depending on prior treatment, may include enfortumab vedotin, erdafitinib (for patients with FGFR2/3 mutations or fusions/rearrangements), sacituzumab govitecan, and platinum rechallenge. For the small proportion of patients ineligible for any platinum-based chemotherapy (i.e., unsuitable for cisplatin or carboplatin), immune checkpoint inhibitor monotherapy with pembrolizumab or atezolizumab is a first-line treatment option, although approved agents vary between countries. In summary, this podcast discusses recent developments in the treatment landscape for advanced urothelial carcinoma, eligibility for platinum-based chemotherapy, potential first-line treatment options, and treatment sequencing. Supplementary file1 (MP4 246907 KB).
摘要：
晚期尿路上皮癌患者的治疗前景继续发展。Enfortumabvedotin联合pembrolizumab已获得食品和药物管理局的批准，根据最近的3期试验数据显示，与一线铂类化疗相比，疗效更好；然而，其独特的毒性特征可能使其不太适合某些患者，一些国家的可用性可能受到成本考虑的限制。因此,铂类化疗有望成为重要的一线治疗选择.选择铂方案（顺铂或卡铂为基础）是通过评估临床特征，包括性能状态，肾功能,以及周围神经病变或心力衰竭的存在。对于完成铂类化疗后无疾病进展的患者，国际指南推荐使用avelumab一线维持治疗.对于疾病进展的患者，pembrolizumab是首选方法。此外,根据最近的第三阶段试验的结果，nivolumab联合以顺铂为基础的化疗也获得了食品和药物管理局的批准,是符合顺铂标准的患者的额外一线治疗选择.晚期尿路上皮癌患者的后期选择，根据以前的治疗，可能包括enfortumabvedotin,erdafitinib（用于FGFR2/3突变或融合/重排的患者），sacituzumabgovitecan,和白金挑战。对于不符合任何铂类化疗条件的一小部分患者(即，不适合顺铂或卡铂），免疫检查点抑制剂单药治疗pembrolizumab或atezolizumab是一线治疗选择，虽然批准的代理商因国家而异。总之,本播客讨论了晚期尿路上皮癌治疗领域的最新进展，铂类化疗的资格，潜在的一线治疗选择，和治疗测序。补充文件1(MP4246907KB)。
