ABSTRACT
Urothelial carcinoma of the bladder is difficult to treat in advanced and metastatic stages. Several factors play a role: age, multimorbidity including impaired renal function and neuropathy make access to life-prolonging chemotherapy impossible in many cases. Improvements of response rates and overall survival in the second-line setting are not much different compared to best supportive care. However, the therapeutic landscape has changed dramatically during the last 2 years. Immunotherapies represented by checkpoint inhibitors have showed positive trial outcomes and have been approved by EMA (European Medicines Agency). Both in second-line therapy after platinum-based chemotherapy and in first-line therapy in unfit patients, these drugs can be used. New concepts with combinations of immunotherapeutic compounds are currently being examined in various trials. If we follow the data of other malignancies (melanoma and non-small cell lung cancer), the future looks optimistic.
Subject(s)
Immunotherapy , Urinary Bladder Neoplasms , Humans , Neoplasm Metastasis/therapy , Urinary Bladder Neoplasms/therapyABSTRACT
In merely a short period of time the comprehension of castration-resistant prostate cancer has evolved. It is now possible to clearly outline the exact definition and variance of the disease pattern. A wealth of new effective agents can be applied to extend the patient's life span and improve the quality of life. An understanding of the pharmacodynamics and side effects of each substance is of utmost importance for the practical application. In order to use these new medicines in a differentiated manner urologists require continuous education. The evaluation of response to treatment has yet to be satisfyingly verified. Molecular markers still need to be developed and evaluated.
