晚期尿道上皮細胞癌接受免疫併化學治療完全緩解-病例報告
鄭人豪、賴谷順、胡如娟、李健儀
台中榮總 外科部 泌尿科
Complete Response of Neoadjuvant Immune Checkpoint inhibitors in advanced Upper Tract Urothelial Carcinoma- a case report.
Jen-Hao Cheng, Lai Gu-Shun, Ju-Chuan Hu, Jian-Ri Li
Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
Introduction: Platinum-based chemotherapy remains the standard of care for first-line treatment of advanced/metastatic urothelial carcinoma. Immune checkpoint inhibitors (ICI) has revolutionized the treatment for cancer patients in recent years. We present a clinical case of advanced upper tract urothelial carcinoma who received Pembrolizumab as second-line therapy with complete response proved by surgery and pathology.
Methods: A 67-year-old female patient, was diagnosed as urothelial carcinoma, high grade of right renal pelvis and metastasized to the retrocaval and inter-aortocaval nodes. She receive chemotherapy with remains with gemcitabine plus cisplatin as first-line therapy for 3 cycles with stable disease. Because of intolerance to continuous chemotherapy, she received pembrolizumab as second-line therapy for 10 cycles.
Results: Regression change in size on Computed Tomography(CT) after pembrolizumab therapy as compare with previous CT. Right nephroureterectomy with bladder cuff excision and lymph node dissection was performed and pathology report revealed infiltrative fibrotic lesion without residual tumor. Grade III Clavien–Dindo complication of duodenal stenosis due to peripheral tissue fibrosis occurred. patient recovered well after gastrojejunal bypass. After thee months follow-up, there was no local recurrence nor distant metastasis.
Conclusions: We presented the first case of combination of neoadjuvant chemotherapy and immunotherapy followed by surgical resection of residual tumor on image study. Currently there is no enough evidence to guided continuous immunotherapy or combined surgery. This case proved a practical experience using combination therapy in the treatment of advanced upper tract urothelial carcinoma. How ever, high grade surgical complication might developed and case selection is very important.