使用Pembrolizumab後完全緩解多發性骨轉移性膀胱癌
高建璋、查岱龍、孫光煥、于大雄、張聖原、吳勝堂
三軍總醫院 外科部 泌尿科
Complete Remission of Multiple Bony-metastatic Bladder Cancer with Pembrolizumab
Chien-Chang Kao, Dai-Lung Cha, Guang-Huan Sun, Dah-Shyong Yu,
Sun-Yran Chang, Sheng-Tang Wu
Divisions of Urology, Department of Surgery, Tri-service general hospital, National Defense Medical Center, Taiwan
Abstract
Case report
A 64-year-old man, with history of benign prostate hyperplasia, presented with painless gross hematuria for a week. A tumor over right posterior bladder wall was found via cystoscopy, and transurethral resection of bladder tumor was performed with pathologic report revealing high grade infiltrating papillary urothelial cell carcinoma of bladder. Pelvic MRI revealed lymph node involvement. Chest CT revealed metastatic nodules over lungs and mediastinum. Whole body bone scan revealed intensely increased uptake of Tc99m MDP over upper frontal skull, left scapula, left 5th rib, right femoral head, right distal femur, suggesting multiple bony metastases. Cranial CT revealed osteolytic bony destruction over frontal bone and a homogenous tumor at right retrobulbar orbital cavity. PET also confirmed the staging to be cT3N3M1.
After 21 cycles of cisplatin-based chemotherapy with altered regimens lasting for one year, disease had progressed and the patient had suffered with persistent bone pain over right femur, which led to his bed-ridden status. Also, depression over frontal skull could be palpated, correlating with his cranial CT. Under Eastern Cooperative Oncology Group (ECOG) performance status score of 2, he started to receive immunotherapy with pemprolizumab in November 2016. After 7 courses, follow-up PET showed complete resolution of distant metastases with no more abnormal FDG uptake throughout whole body, and cranial CT disclosed dramatic improvement in reossified frontal skull. Despite immune-related adverse events including mild pruritus and tolerable fatigue, the patient had also regained his life quality with ECOG performance status score back to 0, suggesting fully ambulatory and was capable of self-care.