Jiang Qi, Xie Mi-Xue, Zhang Xiao-Chen
Department of Medical Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China.
Senior Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China.
World J Clin Cases. 2020 Feb 6;8(3):594-599. doi: 10.12998/wjcc.v8.i3.594.
Targeted treatments may greatly affect the natural history of urothelial carcinoma based on their pharmacokinetics. A phase II trial has explored the combination of cytotoxic chemotherapy with the anti-HER-2 monoclonal antibody trastuzumab in selected patients with metastatic bladder cancer, but it failed.
Here, we report a case of recurrent urothelial bladder carcinoma (UBC) in a patient who has undergone three operations, and further illuminate its diagnosis and treatment. The diagnosis of UBC was rendered according to the pathological indices. Next-generation sequencing on formalin fixed paraffin-embedded (FFPE) tissue was also performed and suggested gene amplification in the FFPE tissue. Based on gene amplification in FFPE, the patient was treated with chemotherapy in combination with trastuzumab after his third surgery. Fortunately, the patient got a clinically complete remission to trastuzumab for 34 mo.
There is not enough clinical evidence for incorporating trastuzumab in routine treatment of UBC. This case hinted that recurrent UBC patients with gene amplification may benefit from targeted trastuzumab. Further studies are needed to further investigate the status of gene and better determine trastuzumab in the management of UBC.
基于其药代动力学，靶向治疗可能会极大地影响尿路上皮癌的自然病程。一项II期试验探索了在部分转移性膀胱癌患者中细胞毒性化疗与抗HER-2单克隆抗体曲妥珠单抗的联合应用，但试验失败了。
在此，我们报告一例复发性尿路上皮膀胱癌（UBC）患者，该患者已接受三次手术，并进一步阐述其诊断与治疗情况。根据病理指标确诊为UBC。还对福尔马林固定石蜡包埋（FFPE）组织进行了二代测序，结果提示FFPE组织中存在基因扩增。基于FFPE中的基因扩增，该患者在第三次手术后接受了化疗联合曲妥珠单抗治疗。幸运的是，该患者对曲妥珠单抗获得了34个月的临床完全缓解。
目前尚无足够的临床证据支持将曲妥珠单抗纳入UBC的常规治疗。该病例提示，基因扩增的复发性UBC患者可能从靶向曲妥珠单抗治疗中获益。需要进一步研究以进一步探究基因状态，并更好地确定曲妥珠单抗在UBC治疗中的作用。
