免疫检查点抑制剂在肌层浸润性膀胱癌新辅助免疫治疗中的研究进展

Research progress of immune checkpoint inhibitors in neoadjuvant immunotherapy for muscle-invasive bladder cancer

肌层浸润性膀胱癌具高度侵袭性,近年来其治疗逐渐综合化。以顺铂为基础的新辅助化疗可显著提高可根治性切除肌层浸润性膀胱癌患者5年生存期,也是目前指南推荐的的术前标准治疗方案。但毒副作用大、对患者身体状态要求高等原因限制了其临床应用。免疫检查点抑制剂相继研发并获批,有证据表明新辅助免疫检查点抑制剂单药治疗的疗效与新辅助化疗相似,能为顺铂不耐受患者所接受且副作用较小。目前新辅助方案研究的热点集中在免疫治疗联合化疗方案,其疗效更佳,但同时不良反应也有所增加。本文将从疗效及安全性方面对各种新辅助免疫治疗方案逐一论述并提出展望。

Muscle-invasive bladder cancer(MIBC)is a highly aggressive tumor.With the development of new therapeutic drugs and clinical research,treatment of MIBC has been gradually integrated.Cisplatin-based neoadjuvant chemotherapy can significantly improve the 5-year survival of patients,and it is the standard preoperative treatment recommended by current guidelines.However,due to the significant side effects and high requirements for the physical status of patients,its use in clinical practice has been restricted.Nowadays,immune checkpoint inhibitors have been successively developed and approved for clinical application.There is evidence that the efficacy of neoadjuvant immune checkpoint inhibitor monotherapy is similar to that of neoadjuvant chemotherapy,and can be accepted by cisplatin-ineligible patients with less side effects.At present,the research hotspot of neoadjuvant regimens is focused on immunotherapy combined with chemotherapy,which is more effective,but the adverse reactions are also increased.This article will review various neoadjuvant immunotherapy regimens in terms of efficacy and safety,and prospect the future direction of development.