Abstract：
BACKGROUND: Bladder cancer is the tenth most common cancer worldwide, with Europe having the highest incidence rates. Regarding the treatment of metastatic disease, first-line treatment for fit patients is cisplatin-containing combination chemotherapy. However, a significant percentage of patients are ineligible for platinum-based chemotherapy, or progress under these regimens. Recently, immune checkpoint blockade has become a treatment option for this group of patients. In this report, we present the case of a male patient diagnosed with metastatic bladder cancer who did not tolerate cisplatin-containing chemotherapy and achieved complete response after treatment with pembrolizumab.
METHODS: A 58 years-old Caucasian man with a medical history of high-grade urothelial carcinoma pT3bN0R0 under a watchful waiting strategy for 6 months presented to the Medical Oncology appointment with two axillary and cervical adenopathies.
METHODS: Cervicothoracoabdominal computed tomography confirmed the presence of two large necrotic lymphadenopathies in the cervical and axillary lymphatic chains, and bone scintigraphy revealed dorsal (D11) and lumbar (L5) metastatic lesions. Ultrasonography-guided biopsy of the axillary nodule revealed the presence of metastatic tissue of primary urothelial origin.
METHODS: The patient was initiated on a palliative chemotherapy regimen of carboplatin area under the curve 5 plus gemcitabine (1000 mg/m2). During the first cycle of chemotherapy, acute kidney failure akin 2 developed due to nonobstructive toxic acute tubular necrosis with progressive deterioration of kidney function. Therefore, palliative chemotherapy with carboplatin plus gemcitabine was changed to 200 mg of pembrolizumab every 21 days.
RESULTS: Overal survival of 57 months with an immune complete response according to the immune Response Evaluation Criteria in Solid Tumours criteria and an excellent quality of life.
CONCLUSIONS: This case illustrates that second-line therapy with ICIs (pembrolizumab or atezolizumab) has favourable results in achieving an immune complete response after intolerance to cisplatin-based regimens. ICIs provide durable responses that improve overall survival and quality of life.
METHODS: A 58 years-old Caucasian man with a medical history of high-grade urothelial carcinoma pT3bN0R0 under a watchful waiting strategy for 6 months presented to the Medical Oncology appointment with two axillary and cervical adenopathies.
METHODS: Cervicothoracoabdominal computed tomography confirmed the presence of two large necrotic lymphadenopathies in the cervical and axillary lymphatic chains, and bone scintigraphy revealed dorsal (D11) and lumbar (L5) metastatic lesions. Ultrasonography-guided biopsy of the axillary nodule revealed the presence of metastatic tissue of primary urothelial origin.
METHODS: The patient was initiated on a palliative chemotherapy regimen of carboplatin area under the curve 5 plus gemcitabine (1000 mg/m2). During the first cycle of chemotherapy, acute kidney failure akin 2 developed due to nonobstructive toxic acute tubular necrosis with progressive deterioration of kidney function. Therefore, palliative chemotherapy with carboplatin plus gemcitabine was changed to 200 mg of pembrolizumab every 21 days.
RESULTS: Overal survival of 57 months with an immune complete response according to the immune Response Evaluation Criteria in Solid Tumours criteria and an excellent quality of life.
CONCLUSIONS: This case illustrates that second-line therapy with ICIs (pembrolizumab or atezolizumab) has favourable results in achieving an immune complete response after intolerance to cisplatin-based regimens. ICIs provide durable responses that improve overall survival and quality of life.
摘要：
背景：膀胱癌是全球第十大常见癌症，欧洲发病率最高。关于转移性疾病的治疗，适合患者的一线治疗是含顺铂的联合化疗.然而,相当比例的患者不符合铂类化疗的条件，或在这些方案下取得进展。最近,免疫检查点阻断已成为这组患者的治疗选择。在这份报告中,我们介绍了一例被诊断为转移性膀胱癌的男性患者,该患者不耐受含顺铂的化疗,并在接受派姆单抗治疗后获得完全缓解.
方法：一名58岁的高加索人，有高级别尿路上皮癌pT3bN0R0病史，在6个月的观察等待策略下，接受内科肿瘤学预约，患有2例腋窝和宫颈腺病。
方法：颈胸腹部计算机断层扫描证实在颈部和腋窝淋巴链中存在两种大的坏死性淋巴结病，骨闪烁显像显示背侧（D11）和腰椎（L5）转移灶。超声引导下的腋窝结节活检显示存在原发性尿路上皮起源的转移组织。
方法：患者开始接受卡铂+吉西他滨（1000mg/m2）的姑息性化疗方案。在化疗的第一个周期，类似于2的急性肾功能衰竭是由于非阻塞性毒性急性肾小管坏死伴随肾功能的进行性恶化而发展的。因此,卡铂+吉西他滨的姑息性化疗方案改为每21天200mgpembrolizumab.
结果：总体存活57个月，根据实体瘤的免疫反应评估标准，免疫完全反应，生活质量优异。
结论：该病例说明ICIs二线治疗（派姆单抗或阿特珠单抗）在对以顺铂为基础的方案不耐受后实现免疫完全反应方面具有良好的结果。ICI提供持久的反应，提高整体生存率和生活质量。
方法：一名58岁的高加索人，有高级别尿路上皮癌pT3bN0R0病史，在6个月的观察等待策略下，接受内科肿瘤学预约，患有2例腋窝和宫颈腺病。
方法：颈胸腹部计算机断层扫描证实在颈部和腋窝淋巴链中存在两种大的坏死性淋巴结病，骨闪烁显像显示背侧（D11）和腰椎（L5）转移灶。超声引导下的腋窝结节活检显示存在原发性尿路上皮起源的转移组织。
方法：患者开始接受卡铂+吉西他滨（1000mg/m2）的姑息性化疗方案。在化疗的第一个周期，类似于2的急性肾功能衰竭是由于非阻塞性毒性急性肾小管坏死伴随肾功能的进行性恶化而发展的。因此,卡铂+吉西他滨的姑息性化疗方案改为每21天200mgpembrolizumab.
结果：总体存活57个月，根据实体瘤的免疫反应评估标准，免疫完全反应，生活质量优异。
结论：该病例说明ICIs二线治疗（派姆单抗或阿特珠单抗）在对以顺铂为基础的方案不耐受后实现免疫完全反应方面具有良好的结果。ICI提供持久的反应，提高整体生存率和生活质量。
