Das Hochrisiko-nicht-muskelinvasive-Harnblasenkarzinom (HR-NMIBC) in Zeiten des BCG-Mangels: was für Optionen haben wir?

Zusammenfassung

Das Hochrisiko-NMIBC ist eine Herausforderung, da es zwar noch nicht muskelinvasiv ist, aber eine hohe Progressionsneigung aufweist. Eine Erfassung der Prognosegruppe ist wichtig und über Nomogramme empfohlen. Neben einer gründlichen transurethralen Resektion empfiehlt sich eine adjuvante Therapie mit BCG, was momentan teils aber nur eingeschränkt verfügbar ist. Daneben ist eine hypertherme Chemotherapie untersucht, deren Datenbasis zum jetzigen Zeitpunkt aber keine breite Anwendung rechtfertigt. Neue Ansätze wie die Checkpoint-Blockade-Inhibition werden untersucht, bieten aber keine Möglichkeit zur breiten praktischen Anwendung bei uns. Eine radikale Zystektomie ist daher in Anbetracht der hohen Progressionsneigung bei ungünstiger Tumorkonstellation immer zu indizieren.

Abstract

High-risk NMIBC is challenging since, although not being muscle-invasive, it is characterised by a high propensity for progression. It is important to determine the prognostic group, which should be done by means of nomograms. Following thorough transurethral resection, adjuvant therapy with BCG is a standard treatment, but BCG is partly unavailable at present due to shortage. Hyperthermic chemotherapy has also been studied, but its broad use is not yet justified based on the data currently available, which also holds true for checkpoint blockade inhibition. Therefore, given the high propensity for progression, early cystectomy is indicated in case of adverse tumour features.

Schlüsselwörter

Hochrisiko-nicht-muskelinvasives-Harnblasenkarzinom - BCG - intravesikale Chemotherapie - Frühzystektomie

Keywords

BCG - intravesical chemotherapy - early cystectomy - high-risk non-muscle-invasive bladder cancer

• Literatur

• 1 Babjuk M, Burger M, Compérat EM. et al. European Association of Urology Guidelines on Non-muscle-invasive Bladder Cancer (TaT1 and Carcinoma In Situ) - 2019 Update. Eur Urol 2019; 76: 639-657
• 2 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S3-Leitlinie Früherkennung, Diagnose, Therapie und Nachsorge des Harnblasenkarzinoms. Langversion 2.0. AWMF-Registrierungsnummer 032/038OL 2020
• 3 Mostafid H, Palou J, Burger M. et al. T1 High-grade Bladder Cancer: The Search for the Optimal Management Continues. Eur Urol 2018; 74: 609-610
• 4 Burger M, Kamat AM, McConkey D. Does Variant Histology Change Management of Non-muscle-invasive Bladder Cancer?. Eur Urol Oncol 2019; pii: S2588-9311(19)30093-8
• 5 Biot C, Rentsch CA, Gsponer JR. et al. Preexisting BCG-specific T cells improve intravesical immunotherapy for bladder cancer. Sci Transl Med 2012; 4: 137ra72
• 6 Khanna A, Yerram N, Zhu H. et al. Utilization of Bacillus Calmette-Guerin for Nonmuscle Invasive Bladder Cancer in an Era of Bacillus Calmette-Guerin Supply Shortages. Urology 2019; 124: 120-126
• 7 Grimm M-O, van der Heijden T, Colombel M. et al. EAU Research Foundation NIMBUS Study Group. Treatment of High-Grade Non-Muscle Invasive Bladder Carcinoma by Standard Number and Dose of BCG instillations Versus Reduced Number and Standard Dose of BCG Instillations: Results of the Phase III Clinical Trial (NIMBUS). Journal of Clinical Oncology 2020; 38 (Suppl. 06) 436
• 8 Rentsch CA, Birkhäuser FD, Biot C. et al. Bacillus Calmette-Guérin strain differences have an impact on clinical outcome in bladder cancer immunotherapy. Eur Urol 2014; 66: 677-688
• 9 Arends TJ, Nativ O, Maffezzini M. et al. Results of a Randomised Controlled Trial Comparing Intravesical Chemohyperthermia with Mitomycin C Versus Bacillus Calmette-Guérin for Adjuvant Treatment of Patients with Intermediate- and High-risk Non-Muscle-invasive Bladder Cancer. Eur Urol 2016; 69: 1046-1052
• 10 Tan WS, Panchal A, Buckley L. et al. Radiofrequency-induced Thermo-chemotherapy Effect Versus a Second Course of Bacillus Calmette-Guérin or Institutional Standard in Patients with Recurrence of Non-muscle-invasive Bladder Cancer Following Induction or Maintenance Bacillus Calmette-Guérin Therapy (HYMN): A Phase III, Open-label, Randomised Controlled Trial. Eur Urol 2019; 75: 63-71
• 11 Aziz A, Gierth M, Fritsche HM. et al. Oncological outcome of primary versus secondary muscle-invasive bladder cancer is comparable after radical cystectomy. Urol Int 2013; 91: 97-102
• 12 Pietzak EJ, Zabor EC, Bagrodia A. et al. Genomic Differences Between "Primary" and "Secondary" Muscle-invasive Bladder Cancer as a Basis for Disparate Outcomes to Cisplatin-based Neoadjuvant Chemotherapy. Eur Urol 2019; 75: 231-239
• 13 Gierth M, Zeman F, Denzinger S. et al. Influence of Body Mass Index on Clinical Outcome Parameters, Complication Rate and Survival after Radical Cystectomy: Evidence from a Prospective European Multicentre Study. Urol Int 2018; 101: 16-24
• 14 Nieuwenhuizen NE, Kulkarni PS, Shaligram U. et al. The recombinant bacille Calmette-Guérin vaccine VPM1002: ready for clinical efficacy testing. Front Immunol 2017; 8: 1-9
• 15 Tse J, Singla N, Ghandour R. et al. Current advances in BCG-unresponsive non-muscle invasive bladder cancer. Expert Opin Investig Drugs 2019; 28: 757-770