Second-line treatment for urothelial carcinoma is unclear. Immunotherapy has shown promising results in this context, but has not been tested in patients with end-stage renal disease (ESRD).
On March 10, 2022, the Karger Medical Electronic Journal reported a clinical case describing a 72-year-old man diagnosed with urothelial carcinoma in 2001 who received pembrolizumab ( A complete remission (CR) was achieved after treatment with pembrolizumab).
Case Study
In 2001, a 72-year-old man presented with gross hematuria without other complications. After consultation with a urologist, the diagnosis was early urothelial carcinoma.
Over the next few years, he underwent several tumor resections, as well as Bacillus and mitomycin Treatment.
In May 2018, he underwent bilateral nephrectomy, cystoprostatectomy, and ureterectomy. Histological diagnosis was high-grade papillary transitional cell carcinoma, multifocal, pT2(m). The patient required hemodialysis (HD) postoperatively.
In December 2018, multiple bilateral lung metastases were found by CT scan, and the lesions were less than 2 cm. Lung biopsy was consistent with urothelial carcinoma metastases. PDL-1 quantification could not be determined due to insufficient samples.
In May 2019, the patient started to receive carboplatin combined with gemcitabine. After 5 cycles, CT scans confirmed disease progression with increased volume of pre-existing lung lesions and the appearance of new lesions.
In October 2019, immunotherapy pembrolizumab (200 mg every 3 weeks) was started as second-line therapy.
Three months later, in January 2020, follow-up imaging showed a reduction in lung metastases, and the doctor assessed the response as a partial response (PR). Regarding toxicity, the patient developed grade 1 rash and pruritus, which resolved with antihistamine therapy.
After 13 months of pembrolizumab, CT scan confirmed complete remission (CR), complete lung metastases Fading.
Discussion
The standard treatment for metastatic urothelial carcinoma is platinum-based chemotherapy. However, systemic chemotherapy tends to have limited efficacy, with an overall response rate of 50-70%, a median progression-free survival of 7-9 months, and a median OS of 12-15 months. Another option for second-line therapy is rechallenge with platinum chemotherapy for patients who have progressed late after first-line therapy. Furthermore, treatment options for second-line therapy are constrained by renal function, which renal function is often compromised by the toxicity of first-line therapy as well as the underlying disease.
The advent of immunotherapy has changed the treatment of metastatic urothelial carcinoma. In this clinical case, pembrolizumab showed good efficacy, and the patient achieved complete remission. In addition, the treatment was well-tolerated, with only mild immune-related adverse events occurring despite the patient’s HD status.
[Important Notice]The information in the article is for reference only, and the specific treatment follow the doctor’s advice!