Chen Yue, Zhou Wenting, Wang Yili
The Oncology Department of the First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China.
Jiangxi Provincial Unit for Clinical Key Oncology Specialty Development, Ganzhou, Jiangxi, China.
Front Immunol. 2024 Dec 24;15:1486200. doi: 10.3389/fimmu.2024.1486200. eCollection 2024.
Uterine clear cell carcinoma (UCCC) is a rare and aggressive subtype of endometrial cancer, often presenting at an advanced stage with poor prognosis. Treatment options for advanced or recurrent UCCC are currently limited, especially after platinum-based chemotherapy has failed.
We present the case of a 49-year-old female diagnosed with stage IV uterine clear cell carcinoma. The patient had a history of atrial fibrillation and initially received several surgical interventions and platinum-based chemotherapy, but these treatments resulted in poor outcomes and rapid tumor progression. Genetic testing showed a high tumor mutation burden (TMB-H, 42.24 mutations/Mb) with stable microsatellites and a suspected harmful mutation in the PMS2 gene. After conventional therapies failed, the patient received a combination treatment of cadonilimab (375 mg) and albumin-bound paclitaxel (380 mg) for six cycles. This was followed by cadonilimab monotherapy for maintenance. This treatment regimen led to a complete response (CR), with no detectable abdominal fluid or enlarged lymph nodes by January 4, 2023. The CR status was maintained during a follow-up on April 07, 2024. The adverse effects included severe myelosuppression, mild skin reactions, hypothyroidism, and Grade 3 hyperglycemia, all of which were managed symptomatically.
This case illustrates how effective AK104/Cadonilimab (a PD-1/CTLA-4 bispecific) can be when combined with albumin-bound paclitaxel for treating advanced UCCC, especially in patients who have not responded to standard therapies. The patient's complete and lasting response shows the potential of PD-1/CTLA-4 bispecific immunotherapy. This suggests that cadonilimab could provide important clinical benefits for patients with advanced or recurrent UCCC.
子宫透明细胞癌（UCCC）是子宫内膜癌中一种罕见且侵袭性强的亚型，常于晚期出现，预后较差。晚期或复发性UCCC的治疗选择目前有限，尤其是在铂类化疗失败后。
我们报告一例49岁女性被诊断为IV期子宫透明细胞癌的病例。该患者有房颤病史，最初接受了几次手术干预和铂类化疗，但这些治疗效果不佳且肿瘤进展迅速。基因检测显示肿瘤突变负荷高（TMB-H，42.24个突变/Mb），微卫星稳定，且PMS2基因存在疑似有害突变。在传统治疗失败后，患者接受了卡度尼利单抗（375 mg）和白蛋白结合型紫杉醇（380 mg）联合治疗六个周期。随后采用卡度尼利单抗单药维持治疗。该治疗方案导致完全缓解（CR），至2023年1月4日未检测到腹腔积液或肿大淋巴结。在2024年4月7日的随访中CR状态得以维持。不良反应包括严重骨髓抑制、轻度皮肤反应、甲状腺功能减退和3级高血糖，所有这些均进行了对症处理。
本病例说明了AK104/卡度尼利单抗（一种PD-1/CTLA-4双特异性抗体）与白蛋白结合型紫杉醇联合治疗晚期UCCC时的有效性，特别是对于对标准治疗无反应的患者。患者的完全且持久的缓解显示了PD-1/CTLA-4双特异性免疫疗法的潜力。这表明卡度尼利单抗可为晚期或复发性UCCC患者提供重要的临床益处。
