PDF(Pubmed)
Abstract：
Urothelial carcinoma of the upper urinary tract (UTUC) presents a significant clinical challenge, often requiring aggressive surgical intervention for optimal management. We present a case of an 84-year-old woman with recurrent high-grade papillary UTUC of the left renal pelvis, refractory to prior endourologic interventions, who underwent neoadjuvant treatment with pembrolizumab and enfortumab vedotin (Pembro/EV) due to contraindications to cisplatin therapy. Following a favorable response to neoadjuvant therapy, the patient underwent laparoscopic left radical nephroureterectomy, achieving a pathologic complete response. We discuss the utility of Pembro/EV in the perioperative management of patients with UTUC, particularly in those ineligible for cisplatin-based therapy. In addition, we highlight the potential role of somatic mutation testing and the integration of novel therapeutic agents such as olaparib in personalized treatment strategies for UTUC. This case underscores the importance of exploring innovative treatment approaches and optimizing patient selection for kidney preservation strategies in the management of UTUC. Further research and clinical trials are warranted to elucidate the full therapeutic potential of Pembro/EV and other emerging therapies in this setting.
摘要：
上尿路尿路上皮癌（UTUC）提出了重大的临床挑战，通常需要积极的手术干预以实现最佳管理。我们介绍了一个84岁的女性，患有左肾盂复发性高级别乳头状UTUC，难以接受先前的腔内干预，由于顺铂治疗禁忌症，他们接受了pembrolizumab和enfortumabvedotin（Pembro/EV）的新辅助治疗。在对新辅助治疗产生良好反应后，患者接受了腹腔镜下左肾癌根治术，达到病理性完全反应。我们讨论了Pembro/EV在UTUC患者围手术期管理中的实用性，特别是在那些不适合顺铂为基础的治疗。此外,我们强调了体细胞突变检测和新型治疗药物如奥拉帕尼在UTUC个性化治疗策略中的潜在作用.此病例强调了在UTUC管理中探索创新治疗方法和优化患者选择肾脏保存策略的重要性。需要进一步的研究和临床试验来阐明Pembro/EV和其他新兴疗法在这种情况下的全部治疗潜力。
