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.
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。