Background:After first-line treatment failure, patients with non-muscle invasive urothelial carcinoma (NMIUC) are recommended to undergo radical cystectomy. However, those unable to pursue radical surgery or desiring bladder preservation require effective salvage therapies. Multi-agent treatment regimens are particularly useful for targeting the complex resistance mechanisms of recurrent UC. Herein, we report a regimen of sequential doxorubicin and gemcitabine alternating weekly with sequential docetaxel and mitomycin (Quad Chemo) for patients with recurrent high-risk NMIUC.Materials and Methods:We retrospectively identified all patients sequentially treated with 50 mg of doxorubicin followed by 1000 mg of gemcitabine alternating weekly with sequential 37.5 mg of docetaxel followed by 40 mg mitomycin-C between 2007–2024. Induction consisted of 8 weekly treatments, and, if disease-free, patients were initiated on monthly maintenance treatments for 2 years.Results:In total, 29 patients (39 treated units; 26 lower urinary tract, 13 upper urinary tract) with high-grade NMIUC were included in the final analysis. The cohort had high-risk features with a median of three prior induction therapies and with 38 (97%) units presented with either biopsy-proven CIS or presumed CIS in the context of high-grade urine cytology in the absence of tumorous lesions. There were 26 recurrences during follow-up, 17 in the lower tract and 9 in the upper tract. Among all of the treated units, the complete response rate was 80%, and 1- and 2-year recurrence-free survival was 60% and 43%, respectively. In total, 10 patients experienced disease progression yielding a 5-year progression-free survival of 57%. Five patients ultimately died due to bladder cancer yielding a 5-year cancer-specific survival of 83%. A total of 19 (66%) patients reported side effects during treatment, and 7 (24%) stopped treatment secondary to side effects.Conclusions:In a high-risk heavily pre-treated cohort, Quad Chemo rescued a significant portion of patients with recurrent NMIUC from disease relapse. However, progression events were considerable in the long term. Further prospective evaluation of this treatment regimen is warranted.
背景：非肌层浸润性尿路上皮癌（NMIUC）患者在一线治疗失败后，通常建议接受根治性膀胱切除术。然而，对于无法进行根治性手术或希望保留膀胱的患者，需要有效的挽救性治疗方案。多药联合治疗方案尤其适用于针对复发性尿路上皮癌复杂的耐药机制。本文报告了一种针对复发性高危NMIUC患者的序贯治疗方案：每周交替使用多柔比星与吉西他滨序贯给药，以及多西他赛与丝裂霉素序贯给药（四联化疗）。 材料与方法：我们回顾性分析了2007年至2024年间所有接受序贯治疗的患者，治疗方案为每周交替进行：先给予50 mg多柔比星，随后给予1000 mg吉西他滨；以及先给予37.5 mg多西他赛，随后给予40 mg丝裂霉素-C。诱导治疗包括每周一次、共8次的治疗；若患者达到无疾病状态，则开始为期2年的每月维持治疗。 结果：最终分析共纳入29例高级别NMIUC患者（39个治疗单元；其中26个为下尿路，13个为上尿路）。该队列具有高危特征：既往中位诱导治疗次数为3次，且38个治疗单元（97%）经活检证实存在原位癌，或在高级别尿细胞学检查提示下推测存在原位癌（未见肿瘤性病变）。随访期间共出现26例复发，其中下尿路17例，上尿路9例。在所有治疗单元中，完全缓解率为80%，1年和2年无复发生存率分别为60%和43%。共有10例患者出现疾病进展，5年无进展生存率为57%。最终有5例患者因膀胱癌死亡，5年癌症特异性生存率为83%。共有19例（66%）患者报告治疗期间出现副作用，其中7例（24%）因副作用而中止治疗。 结论：在高危且经过多次前期治疗的患者队列中，四联化疗使相当一部分复发性NMIUC患者免于疾病复发。然而，长期来看疾病进展事件仍较为显著。有必要对该治疗方案进行进一步的前瞻性评估。
肿瘤(癌症)患者之家