Poon Darren M C, Ho Lap Yin, Kwong Yiu Ming
Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.
J ABLE Medical Center, Hong Kong, Hong Kong SAR, China.
Front Oncol. 2024 May 28;14:1397738. doi: 10.3389/fonc.2024.1397738. eCollection 2024.
Muscle-invasive bladder cancer (MIBC) with nodal involvement is associated with poor prognosis and high mortality. Treatment of node-positive MIBC is complex due to disease heterogeneity and a lack of evidence-based treatment options, especially alternatives to radical cystectomy. We describe a bladder-sparing management approach involving systemic therapy followed by maintenance therapy, illustrated with two cases of node-positive MIBC.
Two patients with node-positive MIBC received upfront gemcitabine/cisplatin chemotherapy, concurrent chemoradiotherapy (cCRT), and avelumab (immune checkpoint inhibitor) maintenance therapy. Both patients achieved complete remission without recurrence or distant metastasis post-avelumab maintenance therapy. At the last follow-up, Patient 1 (45-year-old male) was in remission for over two years, and Patient 2 (57-year-old male) was in complete remission for over one year post-chemotherapy. Avelumab treatment was well-tolerated, with no immune-related adverse events, and quality of life (QoL) was maintained.
Both cases showed a good response and extended remission on avelumab maintenance, supporting its use in conjunction with local consolidation therapy as a bladder-preserving approach in node-positive MIBC. Further research, such as the ongoing INSPIRE trial, is required to refine treatment strategies for this patient group.
伴有淋巴结转移的肌层浸润性膀胱癌(MIBC)预后较差且死亡率高。由于疾病异质性以及缺乏循证治疗方案,尤其是根治性膀胱切除术的替代方案,淋巴结阳性MIBC的治疗较为复杂。我们描述了一种膀胱保留管理方法,包括全身治疗后进行维持治疗,并以两例淋巴结阳性MIBC病例进行说明。
两名淋巴结阳性MIBC患者接受了一线吉西他滨/顺铂化疗、同步放化疗(cCRT)以及阿维鲁单抗(免疫检查点抑制剂)维持治疗。两名患者在阿维鲁单抗维持治疗后均实现完全缓解,无复发或远处转移。在最后一次随访时,患者1(45岁男性)缓解超过两年,患者2(57岁男性)化疗后完全缓解超过一年。阿维鲁单抗治疗耐受性良好,无免疫相关不良事件,生活质量(QoL)得以维持。
两例病例在阿维鲁单抗维持治疗时均显示出良好反应和延长的缓解期,支持将其与局部巩固治疗联合用于淋巴结阳性MIBC的膀胱保留方法。需要进一步的研究,如正在进行的INSPIRE试验,以完善该患者群体的治疗策略。