Cisplatin-based chemotherapy has long been the standard first-line (1L) treatment for metastatic urothelial carcinoma (mUC). However, up to 50% of patients with mUC may be ineligible for cisplatin owing to comorbidities, necessitating alternative primary treatment options. Immune checkpoint inhibitors (ICIs) have emerged as a vital alternative for those unable to receive cisplatin. Nevertheless, the prognosis of advanced UC remains dire and challenges persist in optimizing 1L therapy. Recent medical advancements have redirected attention towards innovative drug combinations for the primary treatment of mUC. The combination of enfortumab vedotin (EV) and pembrolizumab has shown significantly improved overall and progression-free survival rates compared to those with chemotherapy alone. This combination can be used as a 1L treatment for patients with mUC who are cisplatin-ineligible or require alternatives to standard chemotherapy. While platinum-based chemotherapy continues to be essential for many patients, the approval of EV and pembrolizumab as 1L treatments for cisplatin-ineligible patients signifies a major breakthrough in primary cancer care. These therapies offer enhanced outcomes in terms of survival and response rates and highlight the increasing relevance of ICI-containing regimens in frontline cancer care. This review provides an exhaustive overview of the current frontline treatment landscape of mUC and explores new therapeutic strategies, with the aim of facilitating clinical decision-making and guiding therapeutic strategies in patients with mUC.
以顺铂为基础的化疗长期以来一直是转移性尿路上皮癌（mUC）的标准一线（1L）治疗方案。然而，由于合并症的存在，高达50%的mUC患者可能不适合接受顺铂治疗，因此需要替代的一线治疗方案。对于无法接受顺铂治疗的患者，免疫检查点抑制剂（ICIs）已成为一种重要的替代选择。尽管如此，晚期尿路上皮癌的预后仍然严峻，优化一线治疗仍面临挑战。近期的医学进展已将注意力重新引向mUC一线治疗的创新药物组合。与单纯化疗相比，enfortumab vedotin（EV）联合帕博利珠单抗的组合方案显著提高了总生存率和无进展生存率。该组合可作为不适合顺铂治疗或需要替代标准化疗的mUC患者的一线治疗方案。虽然铂类化疗对许多患者仍然至关重要，但EV联合帕博利珠单抗作为不适合顺铂患者的一线治疗方案的获批，标志着癌症一线治疗领域的重大突破。这些疗法在生存率和缓解率方面提供了更好的结果，并突显了含ICI方案在癌症一线治疗中日益增长的重要性。本综述全面概述了当前mUC的一线治疗现状，并探讨了新的治疗策略，旨在促进mUC患者的临床决策并指导治疗策略。
肿瘤(癌症)患者之家