치료 효과, 부작용, 과잉 치료 간의 균형을 고려한 근침윤성 방광암의 수술 전후 치료의 개인화 치료 전략

• Published in: Taehan Ŭisa Hyŏphoe chi pp. 215 - 227
• Main Authors: 송기현, 권휘안, 정의현, 푹보다이홍, 탄트루엉호롱, 서호경
• Format: Journal Article
• Language: Korean
• Published: 대한의사협회 01.04.2025
• Subjects: 기타의약학
• ISSN: 1975-8456
• DOI: 10.5124/jkma.25.0063

Purpose: Muscle-invasive bladder cancer (MIBC) is an aggressive cancer with a high recurrence risk due to micrometastases. Standard treatment, neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy, is not suitable for all patients, with many being ineligible or experiencing recurrence, alongside significant toxicity concerns. Current Concepts: The introduction of immune checkpoint inhibitors (ICIs) into the perioperative setting —including neoadjuvant ICI use in cisplatin-ineligible patients, adjuvant ICI use in high-risk individuals, and chemoimmunotherapy in either the preoperative or postoperative period—has demonstrated promising clinical outcomes. Additionally, bladder preservation strategies are currently under investigation in select patients who exhibit favorable treatment responses, aiming to maintain quality of life without compromising oncologic outcomes. Nevertheless, challenges such as overtreatment, long-term toxicity, and immune-related adverse events remain significant, underscoring the necessity for precise patient selection. Discussion and Conclusion: To personalize perioperative management of MIBC, it is essential to develop and clinically implement robust predictive biomarkers. Assessment of molecular residual disease using circulating tumor DNA is emerging as a promising method to stratify risk, guide adjuvant treatment decisions, and monitor therapeutic response in real time. Future research should prioritize the validation of these biomarkers, refinement of patient selection criteria for bladder preservation strategies, and evaluation of novel therapeutic agents such as antibody-drug conjugates and fibroblast growth factor receptor inhibitors in the perioperative setting. Ultimately, adopting a precision oncology approach will be critical for balancing oncologic efficacy with toxicity management and achieving patient-centered outcomes. KCI Citation Count: 0