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摘要: 2024年欧洲泌尿外科协会(EAU)年会于4月5日—8日在法国巴黎召开，展示了全球泌尿外科领域的最新进展。肌层浸润性膀胱癌(muscle-invasive bladder cancer，MIBC)的临床进展主要集中在新辅助免疫治疗与新辅助化疗联合免疫治疗、根治性膀胱切除术中淋巴结清扫术的范围、转移性膀胱癌的治疗进展等3个方面，本文就相关内容作简要介绍。Abstract: The Annual European Association of Urology(EAU) Congress was held in Paris, France, from April 5th to 8th, 2024, showing the latest developments in the field of urology worldwide. The clinical advances in muscle-invasive bladder cancer(MIBC) mainly focus on three aspects: role of neoadjuvant immunotherapy and chemo-immunotherapy, extent of lymphadectomy in radical cystectomy, and the treatment progress in metastatic bladder cancer. This article provides a brief introduction to the relevant contents.
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表 1 2024 EAU转移性膀胱癌治疗建议
推荐 推荐强度 能够耐受联合治疗的一线治疗 EV(ADC类药物)+帕博利珠单抗(CPI类药物) 强 如果存在EV禁忌证或无EV可用：使用含铂的联合化疗(顺铂或卡铂联合吉西他滨)，然后对化疗后病情至少处于稳定状态的患者使用阿维鲁单抗维持治疗 强 如果存在EV禁忌证或无EV可用，但能够耐受顺铂：建议GC化疗联合纳武利尤单抗 强 如果存在免疫检查点抑制剂治疗禁忌证：建议应用含铂的联合化疗(顺铂或卡铂联合吉西他滨) 强 不能耐受联合治疗的一线治疗 如果PD-1高表达，使用帕博利珠单抗或阿替利珠单抗 弱 二线治疗 一线EV+CPI治疗之后 以铂为基础的联合化疗(顺铂或卡铂联合吉西他滨) 弱 如果存在可控的FGFR基因改变：建议使用厄达替尼 弱 ADC戈沙妥珠单抗(sacituzumab govitecan) 弱 单剂化疗药(多西他赛、紫杉醇、长春氟宁) 弱 一线以铂为基础的化疗+/-CPI治疗之后 EV 强 如果存在可控的FGFR基因改变：建议使用厄达替尼 强 如果一线治疗未使用CPI：建议使用帕博利珠单抗 强 ADC戈沙妥珠单抗(sacituzumab govitecan) 弱 单剂化疗药(多西他赛、紫杉醇、长春氟宁) 弱 接受过EV、CPI及以铂为基础的化疗的后续治疗 一般性声明：提供临床试验进行治疗。如果患者未入组肿瘤特异性系统治疗，建议行最佳支持治疗(BSC) 强 如果存在可控的FGFR基因改变：建议使用厄达替尼 弱 注：ADC为抗体-药物偶联物；CPI为免疫检查点抑制剂；EV：enfortumab vedotin；FGFR为成纤维细胞生长因子受体。 
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