Mir M Carmen, Campi Riccardo, Loriot Yohann, Puente Javier, Giannarini Gianluca, Necchi Andrea, Rouprêt Morgan
Department of Urology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain.
Department of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Eur Urol Oncol. 2022 Dec;5(6):726-731. doi: 10.1016/j.euo.2021.04.004. Epub 2021 May 6.
We describe the case of a 71-yr-old woman with locally advanced muscle-invasive bladder cancer and stage III chronic kidney disease due to an obstructed nonfunctional left kidney. She was started on neoadjuvant immunotherapy, but had to stop treatment because of acute worsening of renal function. Radical cystectomy was then performed uneventfully, revealing pT3aN1 urothelial carcinoma of the bladder. Adjuvant chemotherapy in high-risk locally advanced bladder cancer after radical cystectomy currently poses several challenges, especially for cisplatin-ineligible candidates. Recent data on adjuvant immunotherapy trials suggest a disease-free survival advantage for this subgroup of patients. The current and future role of immuno-oncology agents in this setting is discussed. PATIENT SUMMARY: Patients with advanced bladder cancer might benefit from further chemotherapy or immunotherapy following bladder removal, but it is still unclear which patients benefit the most from this strategy. Measurement of biomarkers and scans to show urinary function will probably help in optimising patient selection for this treatment in the near future.
我们描述了一例71岁女性患者，患有局部晚期肌肉浸润性膀胱癌和因左肾梗阻无功能导致的III期慢性肾脏病。她开始接受新辅助免疫治疗，但因肾功能急性恶化而不得不停止治疗。随后顺利进行了根治性膀胱切除术，结果显示为膀胱pT3aN1尿路上皮癌。根治性膀胱切除术后高危局部晚期膀胱癌的辅助化疗目前面临若干挑战，尤其是对于不符合顺铂治疗条件的患者。近期辅助免疫治疗试验的数据表明，该亚组患者无病生存期有优势。本文讨论了免疫肿瘤药物在这种情况下当前和未来的作用。患者总结：晚期膀胱癌患者在膀胱切除术后可能从进一步化疗或免疫治疗中获益，但仍不清楚哪些患者从该策略中获益最大。生物标志物检测和显示泌尿功能的扫描可能有助于在不久的将来优化该治疗的患者选择。
