免疫點抑制劑作為膀胱泌尿上皮癌患者之術前輔助性治療：單一機構經驗分享
張賀翔、江博暉
高雄長庚紀念醫院 泌尿科
An immune checkpoint inhibitor as neoadjuvant therapy in patients with bladder urothelial carcinoma: preliminary experiences in a single institute
Chang Ho Hsiang, Chiang Po Hui
Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Taiwan
Purpose: Currently, neoadjuvant cisplatin-based combination chemotherapy followed by radical cystectomy is the most common therapy for non-metastatic bladder cancer( cT2-cT4a disease and negative lymph nodes). However, about 50% patient are ineligible in the cisplatin-based combination therapy. The checkpoint inhibitors (PDL1 and PD1) such as pembrolizumab and nivolumab become the alternative option of the therapy.
Materials and Methods: This is a retrospective cohort study. Total five patients were reviewed in this study. All of them received surgical intervention after checkpoint inhibitor immunotherapy during July 2017 to March 2019 in Kaohsiung Chang Gung Memorial Hospital. Baseline clinical characteristics including age, gender, TNM stage, therapy cycle, adverse effect, operations, follow up month, and PD-L1 TPS% were retrospectively collected from our database.
Results: Total five patients in this study, three of them were pT3 and the other two were T2 reviewed. Four patients received 2-3 cycles of pembrolizumab(100-150 mg) and the other one received 3 cycles of nivolumab(200mg). One patient received radical cystectomy. The other four patients received bladder preserving therapy which included three patients of partial cystectomy and one patient of TURBT after neoadjuvant immunotherapy. There was one patient with pT0 (20%) and high PDL1 expression (TPS 60 %). Downstaging to pT1 was achieved in one patient (20%). Downsizing was noted in all patients. Myasthenia gravis was recorded in the patient with complete response.
Conclusions: Immunotherapy is a well-tolerated and active treatment for UC patients. Neoadjuvant checkpoint inhibitors could be safely administered in patients with pT2-cT3N0M0. This preliminary study indicates that the clinical trial of checkpoint inhibitors could be a worthwhile neoadjuvant therapy.