Ni Kangxin, Wang Zhenghui, Yu Shicheng, Zheng Jintong, Li Gonghui
Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Transl Androl Urol. 2021 Apr;10(4):1821-1826. doi: 10.21037/tau-21-268.
Upper tract urothelial carcinoma (UTUC) is a rare malignant disease, and while locally advanced non-metastatic UTUC can be cured by radical nephroureterectomy (RNU), this procedure leaves patients at high risk of relapse and death from cancer. Though the FDA has currently approved five agents for the systemic immunotherapy treatment of urothelial carcinoma (UC) patients, the effect of immunotherapy in patients with recurrent UTUC still lacks specific evidence. Camrelizumab is a programmed cell death protein 1 (PD-1) inhibitor which has been approved for the treatment of recurrent or refractory classical Hodgkin lymphoma in China and have achieved improvement in a verity of solid tumors with manageable safety profile. We herein report a case of an 80-year-old woman diagnosed with localized UTUC (pT4N0M0) for which she underwent RNU but relapsed after 2 months. As the toxic effects of chemotherapy were intolerable for the patient, she received the PD-1 inhibitor Camrelizumab as a salvage treatment to stop tumor growth. The tumor shrank and the patient achieved partial response (PR) after eight cycles but progressed after 14 cycles. Based on the current evidence, our case indicated that Camrelizumab is a promising agent in treating locally advanced and recurrent UTUC patients with poor performance status and imparted renal function.
上尿路尿路上皮癌（UTUC）是一种罕见的恶性疾病，虽然局部晚期非转移性UTUC可通过根治性肾输尿管切除术（RNU）治愈，但该手术使患者面临癌症复发和死亡的高风险。尽管美国食品药品监督管理局（FDA）目前已批准五种药物用于尿路上皮癌（UC）患者的全身免疫治疗，但免疫疗法对复发性UTUC患者的疗效仍缺乏具体证据。卡瑞利珠单抗是一种程序性细胞死亡蛋白1（PD-1）抑制剂，在中国已被批准用于治疗复发或难治性经典霍奇金淋巴瘤，并在多种实体瘤中取得了疗效，且安全性可控。我们在此报告一例80岁女性患者，诊断为局限性UTUC（pT4N0M0），接受了RNU治疗，但2个月后复发。由于患者无法耐受化疗的毒副作用，她接受了PD-1抑制剂卡瑞利珠单抗作为挽救治疗以阻止肿瘤生长。经过八个周期的治疗，肿瘤缩小，患者达到部分缓解（PR），但在14个周期后病情进展。基于目前的证据，我们的病例表明，卡瑞利珠单抗在治疗局部晚期和复发性UTUC患者方面是一种有前景的药物，这些患者身体状况较差且肾功能受损。
