Background: Muscle-invasive bladder cancer (MIBC) represents a highly aggressive malignancy associated with significant morbidity and mortality. The current standard treatment, which includes radical cystectomy and platinum-based chemotherapy, is burdened by high toxicity and a substantial risk of relapse. For this reason, over the past decade, novel therapeutic strategies involving immune checkpoint inhibitors (ICIs), antibody–drug conjugates (ADCs), and targeted therapies have been investigated. This review aims to summarize current clinical evidence and ongoing trials evaluating these approaches in the perioperative setting. Methods: A systematic search was conducted using PubMed, EMBASE, and Cochrane databases, along with abstracts from major oncology conferences (ASCO, ESMO, SGO). Clinical trials assessing ICIs, ADCs, and targeted therapies, either alone or in combination with each other or with chemotherapy, in MIBC, were included. Results: Several early-phase and phase III trials have investigated the perioperative management of MIBC. Various studies evaluated the addition of ICIs to standard chemotherapy, demonstrating promising results in terms of pathological complete response. In parallel, the encouraging outcomes with ICIs and ADCs alone in the neoadjuvant or adjuvant setting paved the way for their combination in integrated strategies. Biomarker-driven approaches, based on circulating tumor DNA and specific genomic alterations, are being actively explored to improve patient selection and personalize treatment. Conclusions: ICIs, ADCs, and targeted therapies are reshaping the therapeutic landscape of MIBC. While early results are promising, further data and biomarker validation are essential to establish their definitive role and guide clinical decision-making in the perioperative setting.
背景：肌层浸润性膀胱癌是一种高度侵袭性的恶性肿瘤，具有显著的发病率和死亡率。目前的标准治疗包括根治性膀胱切除术和铂类化疗，但存在高毒性和高复发风险。因此，在过去十年中，涉及免疫检查点抑制剂、抗体药物偶联物和靶向治疗的新型治疗策略得到了广泛研究。本综述旨在总结当前临床证据以及正在进行的围手术期相关临床试验。 方法：通过PubMed、EMBASE和Cochrane数据库，以及主要肿瘤学会议（ASCO、ESMO、SGO）的摘要进行系统检索。纳入评估免疫检查点抑制剂、抗体药物偶联物和靶向治疗（单独使用或联合化疗）在肌层浸润性膀胱癌中的临床试验。 结果：多项早期和III期临床试验已探讨了肌层浸润性膀胱癌的围手术期管理。多项研究评估了在标准化疗基础上加用免疫检查点抑制剂的效果，在病理完全缓解方面显示出良好前景。同时，免疫检查点抑制剂和抗体药物偶联物在新辅助或辅助治疗中的积极效果为它们在综合策略中的联合应用奠定了基础。基于循环肿瘤DNA和特定基因组改变的生物标志物驱动方法正在积极研究中，以改善患者选择和个体化治疗。 结论：免疫检查点抑制剂、抗体药物偶联物和靶向治疗正在重塑肌层浸润性膀胱癌的治疗格局。尽管早期结果令人鼓舞，但仍需更多数据和生物标志物验证来确定其确切作用，并指导围手术期的临床决策。
The Management of Muscle Invasive Bladder Cancer: State of the Art and Future Perspectives
肿瘤(癌症)患者之家