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Pharmacological treatment of bladder cancer (BC), including intravesical chemotherapy, systemic chemotherapy, chemoradiotherapy, and immunotherapy, still faces major challenges such as high recurrence rates, drug resistance, and treatment-related toxicities. As an important adaptive response under therapeutic stress, autophagy exerts a dual role in BC; it may cooperate with apoptosis and other pathways to mediate tumor cell death, or function as protective autophagy to promote cell survival and drive drug resistance. Therefore, strategies aimed at inducing lethal autophagy or inhibiting therapy-induced protective autophagy/autophagic flux blockade have emerged as potential approaches to optimize treatment response. Active components and compound formulas of traditional Chinese medicine can modulate autophagy through signaling pathways such as AMP-activated protein kinase/mechanistic target of rapamycin (AMPK/mTOR), and have shown potential to suppress tumor growth, enhance therapeutic sensitivity, and reduce toxicity. However, current evidence is still largely limited to in vitro and animal studies, criteria for autophagic flux evaluation remain inconsistent, and systematic studies on pharmacokinetics/pharmacodynamics (PK/PD), drug-drug interactions, and safety are lacking. Based on a systematic review of previous basic and preclinical studies, this article focuses on the representative molecular mechanisms by which active components and compound formulas of traditional Chinese medicine regulate autophagy, as well as their potential benefits and major limitations in the pharmacological treatment of BC, and further proposes possible directions for subsequent combination therapy and optimization of therapeutic strategies from the perspective of clinical pharmacology.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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