Urothelial carcinoma is one of the most common malignancies of the urinary tract, including bladder and urethral malignancies located in the lower urinary tract and renal pelvis and ureteral malignancies located in the upper urinary tract, of which about 90% of urothelial tumors originate in the bladder. Metastatic urothelial carcinoma is a disease with a very high mortality rate, with a median overall survival time (mOS) of only 14 months, and the 5-year survival rate for patients with locally advanced or metastatic disease is only about 5%.
Urothelial carcinoma (UC) is one of the most common malignancies of the genitourinary system and can occur in any part of the urothelium covering the urothelium, including the renal pelvis, ureters, bladder, urethra, and umbilical urethra. Urothelial carcinoma accounts for more than 90% of all bladder cancers, while the remaining 10% are upper urothelial cancers, including ureteral and renal pelvic cancers. Bladder cancer is divided into invasive urothelial carcinoma and non-invasive urothelial carcinoma, which refers to a type of urothelial tumor that has infiltrated below the basement membrane.
Currently, guidelines recommend neoadjuvant chemotherapy plus radical cystectomy or nephroperectomy as the standard treatment for muscle-invasive urothelial carcinoma. At the same time, cisplatin-based combination chemotherapy is used as first-line treatment for patients with unresectable and metastatic advanced urothelial carcinoma.
Immunotherapy
In recent years, immune checkpoint inhibitors have emerged as an effective cancer treatment option, with benefits including:
1. Improve treatment effectiveness: Immune checkpoint inhibitors can activate the body's immune system and enhance the ability to attack cancer cells, thereby improving treatment effectiveness. Some studies have shown that the use of immune checkpoint inhibitors can prolong patient survival.
2. Relatively few side effects: Compared with traditional chemotherapy drugs, immune checkpoint inhibitors have relatively few side effects, including rash, fatigue, nausea, etc.
Immunotherapy drugs that have been marketed for urothelial carcinoma:
1. Tislelizumab (with medical insurance)
Medical insurance: medical insurance reimbursement, category B
Medical insurance price: 1450 yuan per stick
Medicare Indications/Reimbursement Eligibility: It can be used for patients with classical Hodgkin lymphoma who have received at least two prior therapies and patients with locally advanced or metastatic urothelial carcinoma (UC) with high disease expression who have progressed during or after platinum-based chemotherapy or within 12 months of adjuvant neoadjuvant or platinum-containing chemotherapy.
2. Toripalimab (with medical insurance)
Medical insurance: medical insurance reimbursement, category B
Medical insurance price: 1912.96 yuan/240mg
Medical insurance indications/reimbursement conditions: toripalimab is indicated for the treatment of locally advanced or metastatic urothelial carcinoma that has failed platinum-based chemotherapy, including neoadjuvant or adjuvant chemotherapy progression within 12 months
3. Nivolumab
Price: 9260 yuan/bottle(100mg),4591 yuan/bottle(40mg)
China Availability: June 15, 2018
Medical insurance reimbursement: not included in the medical insurance catalogue for the time being
Indications:
1. It is suitable for adjuvant treatment for adult patients with high risk of recurrence after radical resection of urothelial carcinoma.
2. It is suitable for the treatment of adult patients with locally advanced or metastatic urothelial carcinoma who have progressed their disease during or after platinum-containing chemotherapy or within 12 months after adjuvant neoadjuvant or platinum-containing chemotherapy.
4.阿维鲁单抗/BAVENCIO
Indication: Locally advanced or metastatic urothelial carcinoma (UC)
(1) First-line maintenance therapy for urothelial carcinoma
This product is suitable for the maintenance treatment of patients with locally advanced or metastatic urothelial carcinoma who have not progressed in first-line platinum-containing chemotherapy.
(2) Previously treated urothelial carcinoma
This product is indicated for the treatment of patients with locally advanced or metastatic urothelial carcinoma:
(1) disease progression during or after platinum-based chemotherapy in these patients;
(2) Disease progression within 12 months of neoadjuvant therapy or adjuvant platinum-containing chemotherapy.
5. Pembrolizumab
The retail price in China is: 17918 yuan (specification: 100mg/4ml)
Medical insurance reimbursement: not included in the medical insurance reimbursement list
Indications: For the treatment of patients with locally advanced or metastatic urothelial carcinoma.
ADC药
1. Enrosumab
Brief instructions for ennosumab
Chinese name: enrosumab
Trade name: Padcev
英文名:enfortumab vedotin-ejfv
规格：30mg/瓶或20mg/瓶
Manufacturer: Astellas Pharmaceuticals and Pfizer
Listed in China: Not listed in China
靶点:Nectin-4
Indications: PADCEV is a Nectin-4-directed antibody and microtubule inhibitor conjugate indicated for the treatment of adult patients with locally advanced metastatic urothelial carcinoma who have previously received adjuvant therapy with programmed death receptor-1 (PD-1) or programmed death ligand 1 (PD-L1) inhibitors or platinum-containing chemotherapy.
2. Gosatuzumab
Domestic price: ¥8400.00 yuan
Medical insurance reimbursement: not included in medical insurance for the time being
靶点:Trop-2
Indications: For the treatment of locally advanced or metastatic urothelial carcinoma that has received prior platinum-containing chemotherapy and programmed death receptor-1 (PD-1) or programmed death-ligand 1 (PD-L1) inhibitors.
3. Vedisitumab (with medical insurance)
Medical insurance: medical insurance category B
Medical insurance reimbursement conditions:
Limitations: 1. HER2-overexpressing locally advanced or metastatic gastric cancer (including gastroesophageal junction adenocarcinoma) that has received at least 2 systemic chemotherapys;
2. Previous platinum-based chemotherapy with HER2 overexpression for locally advanced or metastatic urothelial carcinoma.
靶点：HER2
Indications: This product is suitable for patients who have received platinum-containing chemotherapy in the past and have locally advanced or metastatic urothelial carcinoma with HER2 overexpression, HER2 overexpression is defined as HER2 immunohistochemical examination results of 2+ or 3+.
Targeted drugs
The mechanism of action of targeted drugs is to inhibit the growth and spread of cancer cells by acting on specific molecules that target them. Compared with traditional chemotherapy drugs, targeted drugs are more selective and targeted, which can reduce the damage to normal cells, thereby reducing side effects. Genetic testing is required before the use of targeted drugs, and the corresponding gene mutations can be used before the drug can be used.
1. Erdafitinib
药品英文名：Erdafitinib
Drug trade name: Balversa
Chinese name of the drug: erdatinib
?? :Erdaini Erdanib
基因靶点：FGFR2或FGFR3
规格剂量：3mg*56片；3mg*84片；4mg*14片；4mg*28片；4mg*56片；5mg*28片；
Manufacturer: JANSSEN BIOTECH of the United States
China listing: On December 15, 2023, according to the official website of CDE, the marketing application of Johnson & Johnson erdafitinib (trade name: Balversa) tablets was accepted: for the treatment of advanced urothelial cancer.
Medicare Reimbursement/Price: Not reimbursable by Medicare
Indications:
For the treatment of adult patients with locally advanced or metastatic urothelial carcinoma (mUC) who have:
（1）易感FGFR3或FGFR2基因改变
(2) Disease progression during or after at least one prior platinum-containing chemotherapy (including neoadjuvant or adjuvant platinum-containing chemotherapy within 12 months).
Laos ASEAN Pharmaceutical Erdatinib
Tips: The medical content involved in this article is a general application suggestion, which is for learning and reference only, and the final opinion is subject to the diagnosis of the clinician.