Vitorino Marina, Santos Catarina
Department of Oncology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal.
Case Rep Oncol. 2022 Mar 10;15(1):187-190. doi: 10.1159/000521979. eCollection 2022 Jan-Apr.
Second-line treatment in urothelial carcinoma is not well defined. Immunotherapy has shown good outcomes in this setting, but it has not been tested in patients with end-stage renal disease (ESRD). We present a clinical case describing the use of pembrolizumab in a patient under hemodialysis (HD) that achieved a complete response. A 72-year-old man was diagnosed with urothelial carcinoma in 2001. Following transurethral resection of the bladder tumor, bacillus Calmette-Guérin, and mitomycin treatment, he underwent surgery in 2018. The patient required HD since surgery. A few months after surgery, there was disease progression with lung metastasis. A first-line treatment with carboplatin and gemcitabine was started, but after 5 cycles, disease progression was confirmed. It was decided to initiate second-line treatment with pembrolizumab. After 13 months of immunotherapy, a CT scan showed a complete response with total involution of lung metastasis. Immune checkpoint inhibitors are an option to second-line treatment in urothelial carcinoma. Further studies are needed to clarify the efficacy and tolerance of this therapy in ESRD patients.
尿路上皮癌的二线治疗尚无明确界定。免疫疗法在这种情况下已显示出良好疗效，但尚未在终末期肾病（ESRD）患者中进行测试。我们报告一例临床病例，描述了在接受血液透析（HD）的患者中使用帕博利珠单抗并取得完全缓解的情况。一名72岁男性于2001年被诊断为尿路上皮癌。在经尿道膀胱肿瘤切除、卡介苗和丝裂霉素治疗后，他于2018年接受了手术。自手术后患者需要血液透析。手术后几个月，出现疾病进展并伴有肺转移。开始使用卡铂和吉西他滨进行一线治疗，但5个周期后，证实疾病进展。决定开始使用帕博利珠单抗进行二线治疗。免疫治疗13个月后，CT扫描显示完全缓解，肺转移灶完全消退。免疫检查点抑制剂是尿路上皮癌二线治疗的一种选择。需要进一步研究以阐明该疗法在ESRD患者中的疗效和耐受性。
