Du Gan, Jiang Zhichao, Qu Wang, Zhang Jin, Zheng Shan, Liu Yueping, Zhou Aiping, Shi Hongzhe, Shou Jianzhong
Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Heliyon. 2024 Mar 11;10(6):e27685. doi: 10.1016/j.heliyon.2024.e27685. eCollection 2024 Mar 30.
The study of bladder preservation for muscle-invasive bladder cancer (MIBC) mainly focuses on the T2 stage, which remains difficult in the T3 and T4 stage. Pembrolizumab has been applied as neoadjuvant therapy followed by radical cystectomy for MIBC, gaining encouraging results in the phase II study. Disitamab vedotin, an antibody-drug conjugate (ADC), also achieved promising efficacy for refractory bladder cancer. However, the neoadjuvant therapy strategy of these drugs for bladder sparing remains further exploration.
A patient with locally advanced MIBC at our institute underwent a neoadjuvant therapeutic regimen followed by transurethral resection of bladder tumor (TURBT) and concurrent chemoradiotherapy. In light of limited initial efficacy, we enacted an adaptive shift in the neoadjuvant treatment strategy, transitioning from a combination of gemcitabine, -platinum, and pembrolizumab to disitamab vedotin with pembrolizumab. This approach ultimately achieved bladder preservation, complete response, and a remarkable 1-year disease-free survival (DFS).
Proactive evaluation in the early stages of tumor downstaging can serve as a guiding principle for neoadjuvant strategies. This is the first successful case of neoadjuvant pembrolizumab combined with disitamab vedotin and chemotherapy in MIBC patients achieving complete response and bladder preservation.
肌肉浸润性膀胱癌（MIBC）膀胱保留的研究主要集中在T2期，T3和T4期仍具有挑战性。帕博利珠单抗已被用作MIBC的新辅助治疗，随后进行根治性膀胱切除术，在II期研究中取得了令人鼓舞的结果。地西他滨维朵汀，一种抗体药物偶联物（ADC），对难治性膀胱癌也取得了有前景的疗效。然而，这些药物用于膀胱保留的新辅助治疗策略仍有待进一步探索。
我院一名局部晚期MIBC患者接受了新辅助治疗方案，随后进行经尿道膀胱肿瘤切除术（TURBT）和同步放化疗。鉴于初始疗效有限，我们对新辅助治疗策略进行了适应性调整，从吉西他滨、铂类和帕博利珠单抗的联合治疗转变为地西他滨维朵汀联合帕博利珠单抗治疗。这种方法最终实现了膀胱保留、完全缓解以及显著的1年无病生存期（DFS）。
在肿瘤降期早期进行积极评估可作为新辅助策略的指导原则。这是首例新辅助帕博利珠单抗联合地西他滨维朵汀及化疗使MIBC患者实现完全缓解并保留膀胱的成功病例。
