Mini-review: Immunotherapy in Bladder Urothelial Cancer in Taiwan: Present and Future Perspective

免疫治療在台灣泌尿上皮癌的現況與願景

歐宴泉(Yen-Chuan Ou) ； 張光喜(Kuang-Hsi Chang) ； 陳鴻霖(Hung-Lin Chen)

《童綜合醫學雜誌》 15卷S期 (2021/09) Pp. 7-12

https://doi.org/10.3966/20713592202109150S002

摘要

Bladder cancer is the most common malignancy in the urinary system. The major type of bladder cancer is urothelial cancer, which accounts for 90% of all bladder cancers in the United States and Europe. Recently approved immunotherapy drugs offer a promising alternative to treating locally advanced urothelial cancer. The new immunotherapy is delivered by immune checkpoint inhibitors. The molecular mechanism of this immunotherapy involves blocking the activation of the PD-1/PD-L1 signaling pathway. Programmed death-1 ligand (PD-L1) is a protein receptor expressed on the surface membrane of cancer cells. Its function is to bind with PD-1 on the surface of immune cells to activate the cell death program in immune cells. From 2016 to 2017, the U.S. Food and Drug Administration approved the applications for five immune checkpoint inhibitor drugs for second-line urothelial cancer treatment, namely, pembrolizumab, atezolizumab, nivolumab, durvalumab, and avelumab. All five drugs are also currently available in Taiwan. Many patients are interested to know the efficacy of immune checkpoint drugs in urothelial cancer. Here, we discuss results of the first- and second-line clinical trials for these checkpoint inhibitors to provide patients and clinicians the information to select the most suitable immunotherapy drug.

關鍵字

Immunotherapy ； PD-1/ PD-L1 ； immune checkpoint inhibitors ； bladder urothelial cancer

並列摘要

膀胱癌是泌尿系統最常見的惡性腫瘤。根據美國及歐洲統計報告，有九成的膀胱癌屬於泌尿上皮細胞癌。近年來，免疫檢查點抑制劑成為局部晚期泌尿上皮癌病人熱門討論的新穎療法。免疫檢查點抑制劑的生物機制在於阻絕PD-1/PD-L1的訊息傳遞。PD-L1是表現在癌細胞表面的一種蛋白，它的功能是與免疫細胞表面上的PD-1受體結合，啟動該免疫細胞的自我死亡程序，最終癌細胞便可遠離免疫系統的攻擊而存活在體內。藉由免疫檢查點抑制劑阻斷PD-1/PD-L1的訊息傳遞，自體免疫系統便可辨認及殺死癌細胞。在2016至2017年，美國食品藥物管理局核准5種免疫檢查點抑制劑作為泌尿上皮癌的二線治療，台灣食品藥物管理局近期也給予核可（Pembrolizumab, Atezolizumab, Nivolumab, Durvalumab, and Avelumab）。此篇文章在於討論這些新穎免疫檢查點抑制劑在泌尿上皮癌作為一線與二線的臨床試驗結果，提供醫師與病患在進行治療計畫時可以做為參考的資料。

並列關鍵字

免疫治療 ； 免疫檢查點抑制劑 ； 膀胱泌尿上皮癌