medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-22-52-57medsovet-7237Research ArticleОНКОУРОЛОГИЯONCOUROLOGYЛечение метастатического рака мочевого пузыря: исторические и современные аспектыTreatment of metastatic bladder cancer: current and historical aspectshttps://orcid.org/0000-0003-4443-9974РумянцевА. А.RumyantsevA. A.

Румянцев Алексей Александрович, к.м.н., старший научный сотрудник онкологического отделения лекарственных методов лечения (химиотерапевтическое) №4 отдела лекарственного лечения

115478, Россия, Москва, Каширское шоссе, д. 24

Alexey А. Rumyantsev, Cand. Sci. (Med.), Senior Research Associate, Cancer Drug Therapy (Chemotherapeutic) Department No. 4, Medication-Based Treatment Unit

24, Kashirskoye Shosse, Moscow, 115478

alexeymma@gmail.comНациональный медицинский исследовательский центр онкологии имени Н.Н. БлохинаРоссияBlokhin National Medical Research Center of OncologyRussian Federation2022061220220225257Copyright © Румянцев А.А., 20222022Румянцев А.А.Rumyantsev A.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7237

Стандарт современной терапии метастатического уротелиального рака (рак мочевого пузыря или других отделов мочевыводящих путей) – проведение системной платиносодержащей химиотерапии, однако, несмотря на высокую непосредственную эффективность терапии (до 70% частоты объективного ответа), отдаленные результаты лечения остаются неудовлетворительными: медиана выживаемости без прогрессирования составляет около 6 мес., а общей выживаемости приблизительно 12 мес., пациенты с висцеральными метастазами или ослабленным общим состоянием характеризуются особенно неблагоприятным прогнозом. Стандарт современного лечения данного заболевания – проведение цисплатин-содержащей химиотерапии, при этом наибольшую эффективность демонстрируют режимы ddMVAC (метотрексат, винбластин, доксорубицин, цисплатин) и GC (гемцитабин, цисплатин), однако в реальной клинической практике меньшая часть пациентов может перенести данные варианты лечения. Последние достижения в лечении уротериального рака связаны с открытиями в области иммунотерапии данного заболевания за счет воздействия на сигнальный путь PD-1/PD-L1. Наиболее перспективные результаты в первой линии лечения данного заболевания демонстрирует стратегия, основанная на последовательном применении цисплатин-содержащей химиотерапии с поддерживающей терапией авелумабом – препаратом, доказанно увеличивающим общую выживаемость пациентов. В данной статье рассмотрены ключевые данные о непосредственной и отдаленной эффективности системной терапии метастатического уротелиального рака, а также потенциальные пути улучшения результатов лечения пациентов с этим заболеванием – в первую очередь за счет внедрения в широкую клиническую практику поддерживающей иммунотерапии и расширения категории пациентов, которым может быть проведена платиносодержащая химиотерапия.

The “state-of-art” treatment approach for patients with metastatic urothelial cancer (eg, bladder cancer or other urothelial tumors of urinary tract) is platinum-containing chemotherapy, however, despite the high immediate efficacy of therapy (up to 70% of the objective response rate), long-term results of treatment remain unsatisfactory, median progression-free and overall survival usually do not exceed 6 and 12 months respectively, patients with visceral metastases or poor performance status have a particularly dismal prognosis. The most effective treatment for this disease is cisplatin-containing chemotherapy, ddMVAC (methotrexate, vinblastine, doxorubicin, cisplatin) and GC (gemcitabine, cisplatin) regimens are most effective, however, in real world setting a minority of patients can tolerate these treatment options. Recent advances in the treatment of urothelial cancer are associated with discoveries in the field of immunotherapy for this disease by targeting the PD-1/PD-L1 pathway. The most promising results in the first line of treatment for this disease based on the sequential use of cisplatin-containing chemotherapy with maintenance avelumab therapy, the latter drug has been proven to increase the overall survival of patients with metastatic urothelial cancer. This article discusses key data on the immediate and long-term effectiveness of systemic therapy for metastatic urothelial cancer, as well as potential ways to improve the results of treatment of patients with this disease, primarily through the introduction of maintenance immunotherapy into real world clinical practice and expanding the category of patients who are eligible for platinum-containing chemotherapy.

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The authors declare that there are no conflicts of interest present.