Onkológia 4/2022

Perioperative treatment of muscle-infiltrating urothelial carcinomas

Radical cystectomy has a key role in treatment of muscle-infiltrating local and locally advanced malignant tumors of the bladder. In cisplatinfit individuals, combined chemotherapy improves survival compared to local treatment alone. The most often used regimens in neoadjuvant intention are gemcitabine with cisplatin (GC) and a dose-dense regimen methotrexate, vinblastine and adriamycin with cisplatin (ddMVAC). There is no standard systemic treatment for a half of the patients who are cisplatin-unfit. Approximately 50% of patients after neoadjuvant therapy and radical surgery have high-risk residual disease. Adjuvant cisplatin-based chemotherapy improves survival in individuals after radical cystectomy without neoadjuvant therapy. Nivolumab is approved for treatment of patients with PD-L1 positive tumors after neoadjuvant treatment and radical surgery with ypT2-ypT4a and/or ypN+ residual disease. It is also approved for treatment of patients with PD-L1 positive tumors after cystectomy without neoadjuvant chemotherapy who are not fit or refuse cisplatin-based adjuvant treatment.

Keywords: urothelial carcinoma, bladder, neoadjuvant therapy, cisplatin, nivolumab