Clinical recommendations for diagnosis, treatment and monitoring of patients with bladder cancer
Marijana Jazvić, Boris Ružić, Božo Krušlin, Marijan Šitum, Valdi Pešutić Pisac, Tomislav Omrčen, Tihana Boraska Jelavić, Željko Kaštelan, Marija Gamulin, Ana Marija Alduk, Marijana Čorić, Jure Murgić, Berislav Mažuran, Kristina Šitum, Maja Drežnjak Madunić, Damir Miletić, Željko Vojnović
Bladder cancer is the second most common malignancy of urinary system according to data from the Croatian National Cancer Registry for 2015. In 90% of cases the underlying histology is urothelial carcinoma. Difference in survival in patients with muscle-invasive disease (MIBC) compared to the survival of patients with non-muscle invasive disease (NMIBC) is enormous. Management of NMIBC, traditionally, has been focused on the reduction of subsequent bladder recurrence and prevention of disease progression and is primarily based on transurethral resection (TUR) of the tumor, followed by intravesical therapy based on estimated individual risk of recurrence. Conversely, in patients with MIBC radical cystectomy remains the cornerstone of the treatment, optimally in conjunction with neoadjuvant platinum-based chemotherapy in cisplatin-eligible patients. At the moment of diagnosis, 4–6% of patients already have distant metastases, and post-cystectomy recurrence could be expected in 50% of patients. Treatment options in metastatic disease range from cisplatin-based chemotherapy, immunotherapy, palliative radiotherapy and finally supportive care. Landmark feature of bladder cancer is the high prevalence of somatic mutations which enabled profound change for decades held treatment paradigm for advanced bladder cancer leading to regulatory approval of whole array of novel immunotherapy agents. These emerging therapeutics (programmed death ligand-1 (PD-L1) and programmed cell death protein-1 (PD-1)) belong to the class of inhibitors of checkpoint proteins, which are key targets that regulate T-cell mediated immune response.
Ana Marija Alduk, Berislav Mažuran, Boris Ružić, Božo Krušlin, Damir Miletić, Jure Murgić, Kristina Šitum, Maja Drežnjak Madunić, Marija Gamulin, Marijan Šitum, Marijana Jazvić, Marijana Ćorić, Tihana Boraska Jelavić, Tomislav Omrčen, Valdi Pešutić Pisac, Željko Kaštelan, Željko Vojnovič