Neo- oder adjuvante Chemotherapie beim Harnblasenkarzinom?

Zusammenfassung

Das fortgeschrittene Urothelkarzinom der Harnblase ist ein Tumor, der häufig metastasiert und daher meist nur eine Lebenserwartung von wenigen Monaten bis Jahren zur Folge hat. Die neoadjuvante Chemotherapie vor kurativer Operation kann in einem Downstaging des Tumors und einer Verbesserung des Gesamtüberlebens resultieren. Eine adjuvante Systemtherapie wird aufgrund der gegenwärtigen Datenlage bislang nur zurückhaltend empfohlen. Am ehesten scheinen Patienten mit einer lymphknotenpositiven Erkrankung hiervon zu profitieren. Falls es die Tumorlokalisation zulässt, kann eine Metastasenresektion die Prognose verbessern. In der metastasierten Situation wird aufgrund der geringeren Nebenwirkungen bei gleichen Ansprechraten die Kombination von Gemcitabin und Cisplatin dem MVAC Regime (Methotrexat, Vinblastin, Adriamycin, Cisplatin) vorgezogen. Vinflunin hat in der Zweitliniensituation nach Platinversagen einen festen Stellenwert.

Abstract

Advanced urothelial carcinoma of the bladder is associated with a high metastatic potential. Life expectancy for metastatic patients is poor and rarely exceeds more than one year without further therapy. Neoadjuvant chemotherapy can decrease the tumour burden while reducing the risk of death. Adjuvant chemotherapy has been discussed controversially. Patients with lymph node-positive metastases seem to benefit the most from adjuvant chemotherapy. In selected patients, metastasectomy can prolong survival. In metastastic patients, the combination of gemcitabine and cisplatin has become the new standard regimen due to a lower toxicity in comparison to the combination of methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC). For second-line treatment, vinflunine is the only approved therapeutic agent.

Schlüsselwörter

Harnblasenkarzinom - neoadjuvante Chemotherapie - adjuvante Chemotherapie - induktive Chemotherapie - Metastasenresektion

Key words

bladder cancer - neoadjuvant chemotherapy - adjuvant chemotherapy - inductive chemotherapy - metastasectomy

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