Ikarashi Daiki, Kitano Shigehisa, Ishida Kazuyuki, Nakatsura Tetsuya, Shimodate Hitoshi, Tsuyukubo Takashi, Tamura Daichi, Kato Renpei, Sugai Tamotsu, Obara Wataru
Department of Urology, Iwate Medical University School of Medicine, Iwate, Japan.
Division of Cancer Immunotherapy Development, Advanced Medical Development Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research Ariake, Tokyo, Japan.
Front Oncol. 2020 Sep 24;10:564714. doi: 10.3389/fonc.2020.564714. eCollection 2020.
Treatment options as second-line therapy for advanced ureteral carcinoma are limited, and patients experiencing recurrence after first-line cisplatin-based chemotherapy have a poor prognosis. Recently, the programmed death-1 (PD-1) inhibitor pembrolizumab provided a better survival benefit with a complete response rate (9.2%) for chemoresistatant urothelial carcinoma. However, the dynamic changes of the cancer microenvironment about the cases of complete response are still unknown. We herein report a case of a 57-year-old man who had been diagnosed with localized, non-muscle-invasive bladder cancer (pT1N0M0, high grade), for which he underwent transurethral resection of the bladder cancer twice. Given that gemcitabine plus carboplatin as first-line neoadjuvant chemotherapy was unable to control left vesico-ureteral junction recurrence with muscle invasion (T3N0M0, high grade), the patient received the PD-1 inhibitor pembrolizumab as second-line neoadjuvant therapy in an attempt to stop tumor growth, which promoted dramatic tumor shrinkage without serious adverse effects and allowed subsequent nephroureterectomy and lymphadenectomy. To the best of our knowledge, this has been the first study to report that pembrolizumab administration before surgery for chemotherapy-resistant ureteral carcinoma promoted a pathological complete response, providing a better understanding of the cancer microenvironment after immunotherapy.
晚期输尿管癌的二线治疗选择有限，一线基于顺铂的化疗后复发的患者预后较差。最近，程序性死亡-1（PD-1）抑制剂派姆单抗对化疗耐药的尿路上皮癌显示出更好的生存获益，完全缓解率为9.2%。然而，关于完全缓解病例的癌症微环境动态变化仍不清楚。我们在此报告一例57岁男性，他被诊断为局限性非肌层浸润性膀胱癌（pT1N0M0，高级别），为此他接受了两次经尿道膀胱癌切除术。鉴于吉西他滨联合卡铂作为一线新辅助化疗无法控制左膀胱输尿管交界处伴肌层浸润的复发（T3N0M0，高级别），该患者接受派姆单抗作为二线新辅助治疗，试图阻止肿瘤生长，这促使肿瘤显著缩小且无严重不良反应，并允许随后进行肾输尿管切除术和淋巴结清扫术。据我们所知，这是第一项报告术前使用派姆单抗治疗化疗耐药性输尿管癌可促进病理完全缓解的研究，有助于更好地了解免疫治疗后的癌症微环境。
