Growing evidence suggests that many patients with high-risk non-muscle invasive urothelial carcinoma (NMIUC) can undergo bladder-sparing management with salvage intravesical therapies. However, inherent or developed disease resistance, particularly after multiple lines of prior salvage therapy, implores the continued pursuit of new treatment combinations. Herein, we describe the outcomes of 26 patients (31 treated units; 24 lower tract, 7 upper tract) with high-risk NMIUC treated with sequential intravesical gemcitabine and cabazitaxel with concomitant intravenous pembrolizumab (GCP) at the University of Iowa from August 2020 to February 2023. Median (IQR) follow-up was 30 (IQR: 17–35) months. Treated units had a history of high-risk NMIUC with a median of four prior endoluminal inductions. Overall, 87% of units presented with CIS or positive urine cytology. The 1- and 2-year recurrence-free survival was 77% (CI: 58–88%) and 52% (CI: 30–70%), respectively. The 2-year progression-free and cancer-specific survival was 70% (CI: 44–85%) and 96% (CI: 75–99%), respectively. In total, 22/26 (85%) patients reported any adverse event and 5/26 (19%) reported a grade ≥3 adverse event; however, all patients tolerated a full induction course. These results suggest that GCP is an effective and tolerable treatment option for patients with recurrent high-risk NMIUC.
越来越多的证据表明，许多高风险非肌层浸润性尿路上皮癌（NMIUC）患者可通过挽救性膀胱内治疗实现保膀胱管理。然而，疾病固有的或继发的耐药性，尤其是在经历多线既往挽救治疗后，促使我们持续探索新的联合治疗方案。本文报道了2020年8月至2023年2月期间在爱荷华大学接受序贯膀胱内吉西他滨联合卡巴他赛并同步静脉帕博利珠单抗（GCP方案）治疗的26例高风险NMIUC患者（共31个治疗单元：24例下尿路，7例上尿路）的临床结局。中位随访时间为30个月（四分位距：17-35个月）。所有治疗单元均有高风险NMIUC病史，既往中位接受过4次腔内诱导治疗。总体而言，87%的治疗单元存在原位癌或尿细胞学阳性。1年和2年无复发生存率分别为77%（置信区间：58-88%）和52%（置信区间：30-70%）。2年无进展生存率和癌症特异性生存率分别为70%（置信区间：44-85%）和96%（置信区间：75-99%）。总计22/26（85%）例患者报告了任何级别不良事件，5/26（19%）例患者报告了≥3级不良事件；但所有患者均完成了完整诱导疗程。这些结果表明，GCP方案对于复发性高风险NMIUC患者是一种有效且耐受性良好的治疗选择。
肿瘤(癌症)患者之家