Personalisierte Therapie beim metastasierten Urothelkarzinom – Vision oder Wirklichkeit?

Abstract

BackgroundFor many years personalized treatment of metastatic urothelial cancer (mUC) was not a priority topic in clinical treatment and research. This has changed in recent years and gene sequencing as well as the development of predictive biomarkers have also become important for UC. Alterations in fibroblast growth factor receptor 2/3 (FGFR2/3) have become established as tumor drivers and patient selection according to FGFR mutations and fusions is already included in the European guidelines of oncological and urological societies.ObjectiveThe aim of this narrative review is the presentation of the current data situation and the clinical relevance of personalized treatment for mUC.Material and methodsNo systematic review was performed.ResultsPatients with selective alterations should be included in studies or treated in the sense of individual treatment attempts according to the decision of the molecular tumor board. The data of the FGFR inhibitor erdafitinib, which has already been approved in the USA, show a response rate of 40% in pretreated patients. Other mutations, such as in the BRCA1/2 gene or TSC1, could also be therapeutically groundbreaking; however, the clinical evidence for this is still lacking. Studies involving genomically selected patients with monotherapy or combinations in treatment naïve and pretreated patients are currently ongoing and will provide more information about future treatment options and strategies.ConclusionPersonalized treatment for mUC in selected patients is a promising and effective approach and will improve the prognosis of UC patients, which has stagnated for many years.