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Optimizing pharmacokinetics of intravesical chemotherapy for bladder cancer.
Nature Reviews Urology ( IF 12.1 ) Pub Date : 2019-08-21 , DOI: 10.1038/s41585-019-0220-4 Gregory A Joice 1 , Trinity J Bivalacqua 1 , Max Kates 1
Nature Reviews Urology ( IF 12.1 ) Pub Date : 2019-08-21 , DOI: 10.1038/s41585-019-0220-4 Gregory A Joice 1 , Trinity J Bivalacqua 1 , Max Kates 1
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Non-muscle-invasive bladder cancer (NMIBC) remains one of the most common malignancies and is associated with considerable treatment costs. Patients with intermediate-risk or high-risk disease can be treated with intravesical BCG, but many of these patients will experience tumour recurrence, despite adequate treatment. Standard of care in these patients is radical cystectomy with urinary diversion, but this approach is associated with considerable morbidity and lifestyle modification. As an alternative, perioperative intravesical chemotherapy is recommended for low-risk papillary NMIBC, and induction intravesical chemotherapy is an option for patients with intermediate-risk NMIBC and BCG-unresponsive NMIBC. However, poor pharmaceutical absorption and drug washout during normal voiding can limit sustained drug concentrations in the urothelium, which reduces efficacy, and small-molecule chemotherapeutic agents can be absorbed through the urothelium into the bloodstream, leading to systemic adverse effects. Several novel drug delivery methods - including hyperthermia, mechanical sustained released devices and nanoparticle drug conjugation - have been developed to overcome these limitations. These novel methods have the potential to be combined with established chemotherapeutic agents to change the paradigm of NMIBC treatment.
中文翻译：
优化膀胱癌膀胱内化疗的药代动力学。
非肌肉浸润性膀胱癌（NMIBC）仍然是最常见的恶性肿瘤之一，并且与可观的治疗费用相关。患有中危或高危疾病的患者可以接受膀胱内BCG治疗，但是尽管进行了适当的治疗，但其中许多患者仍会出现肿瘤复发。这些患者的标准护理是行膀胱膀胱切除术并转移尿液，但是这种方法会导致较高的发病率和生活方式的改变。作为替代方案，对于低危乳头状NMIBC，建议围手术期进行膀胱内化疗，对于中危NMIBC和BCG无反应的NMIBC患者，诱导膀胱内化疗是一种选择。但是，正常排尿期间不良的药物吸收和药物冲洗会限制尿路上皮中持续的药物浓度，这会降低功效，小分子化学治疗剂可通过尿路上皮吸收到血液中，从而导致全身性不良反应。为了克服这些局限性，已经开发了几种新颖的药物递送方法，包括热疗，机械缓释装置和纳米颗粒药物结合。这些新颖的方法有可能与已建立的化学治疗剂结合以改变NMIBC治疗的范例。
更新日期：2019-08-22
中文翻译：
优化膀胱癌膀胱内化疗的药代动力学。
非肌肉浸润性膀胱癌（NMIBC）仍然是最常见的恶性肿瘤之一，并且与可观的治疗费用相关。患有中危或高危疾病的患者可以接受膀胱内BCG治疗，但是尽管进行了适当的治疗，但其中许多患者仍会出现肿瘤复发。这些患者的标准护理是行膀胱膀胱切除术并转移尿液，但是这种方法会导致较高的发病率和生活方式的改变。作为替代方案，对于低危乳头状NMIBC，建议围手术期进行膀胱内化疗，对于中危NMIBC和BCG无反应的NMIBC患者，诱导膀胱内化疗是一种选择。但是，正常排尿期间不良的药物吸收和药物冲洗会限制尿路上皮中持续的药物浓度，这会降低功效，小分子化学治疗剂可通过尿路上皮吸收到血液中，从而导致全身性不良反应。为了克服这些局限性，已经开发了几种新颖的药物递送方法，包括热疗，机械缓释装置和纳米颗粒药物结合。这些新颖的方法有可能与已建立的化学治疗剂结合以改变NMIBC治疗的范例。
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