Immunotherapy showed miraculous effects, advanced bladder cancer combined with uremia, the lesions completely disappeared!

The urinary system is an important functional part of the human body.
Due to the existence of many risk factors such as smoking, drinking too little water, and exposure to harmful chemicals, the urinary system can also develop tumor diseases, of which the bladder is one of the most common disease sites
.

Among bladder cancers, urothelial carcinoma is the most common
.

Figure 1.
Urothelial carcinoma At present, systemic chemotherapy is the first-line standard treatment to inhibit the further progression of metastatic bladder cancer, but its efficacy is not satisfactory.
The median survival time of urothelial carcinoma patients is about one year to one and a half years
.

This is because there is no standard second-line therapy after progression on first-line therapy
.

With the advent of immunotherapy, immune checkpoint inhibitors (ICIs) have shown promising anti-tumor effects in various types of solid tumors, including bladder cancer
.

In KEYNOTE-012 (Phase IB clinical trial), KEYNOTE-052 (Phase II), KEYNOTE-045 (Phase III) and other clinical studies, pembrolizumab (Pembrolizumab, K drug) can be compared with systemic chemotherapy, can Better prolong survival of patients with urothelial carcinoma
.

However, in order to ensure safety, clinical trials generally do not include patients with poor medical conditions, including patients with end-stage renal disease (ESRD)
.

ESRD is the end stage of various chronic kidney diseases (the glomerular filtration rate is less than 15ml/min), which is what we often call "uremia".
These patients generally require dialysis treatment to effectively excrete toxins from the body
.

Is immunotherapy effective for patients with end-stage renal disease/uremia? Clinical investigators have recently provided us with some evidence through a treatment example
.

The case dates back to 2001.
Mr.
Liu, 72, suddenly developed hematuria when urinating
.

He immediately went to the local urology department for a detailed examination.
Unfortunately, he was diagnosed with bladder cancer.
Fortunately, the tumor was still in the early stage (pTa)
.

In the following years, Mr.
Liu received transurethral resection of bladder tumor, BCG and mitomycin therapy successively
.

But the tumor didn't stop there
.

In May 2018, Mr.
Liu had to undergo bilateral nephrectomy, cystoprostatectomy, and ureterectomy, but fortunately, there was no distant metastasis
.

However, due to the loss of renal filtration function, Mr.
Liu started dialysis treatment since then
.

Six months later (December 2018), Mr.
Liu’s routine CT examination found multiple “round-like lesions” in the lungs with a diameter of less than 2cm.
Further histological examination confirmed that these “uninvited guests” were transferred from bladder cancer through the blood tract.

.

Obviously, the radical operation failed to stop the tumor, and the tumor spread by blood
.

Due to insufficient samples of metastatic lesions in lung biopsy, doctors could not accurately determine whether Mr.
Liu's tumor had highly expressed programmed death receptor ligand (PD-L1)
.

At this time, Mr.
Liu could only accept first-line standard chemotherapy
.

After five cycles of gemcitabine combined with carboplatin (GC) chemotherapy, a re-examination of chest CT found that Mr.
Liu's lung lesions increased and new lesions appeared at the same time.
The GC chemotherapy regimen could no longer control his condition
.

At that time, there was no guideline for the second-line treatment of urothelial carcinoma, that is, there was no anti-tumor regimen with proven efficacy
.

Since pembrolizumab showed good efficacy in solid tumors at that time, after repeated discussions, the doctor suggested Mr.
Liu to use pembrolizumab (200mg, q3w) as the second-line treatment
.

From October 2019, Mr.
Liu began to receive this program, while continuing to receive hemodialysis treatment
.

Two months later, Mr.
Liu felt his symptoms improved.
The chest CT results showed that the lung metastases were significantly reduced, and the curative effect reached a partial remission (PR)
.

After receiving pembrolizumab for 13 months, Mr.
Liu's lung metastases disappeared and the curative effect reached a complete remission (CR)
.

During the treatment, Mr.
Liu only had a mild skin reaction and recovered after anti-allergic treatment
.

Summary and Implications In this case, the patient had end-stage renal disease and was receiving long-term dialysis treatment
.

After failure of first-line standard therapy, second-line immunotherapy resulted in complete remission of pulmonary metastases
.

This suggests that immune checkpoint inhibitors have potential for second-line treatment of urothelial cancer patients with end-stage renal disease and long-term dialysis
.

Of course, these efficacy and safety data need to be confirmed by sample-based clinical trials
.

Immunotherapy has brought new treatment options for a variety of solid tumors, including urothelial carcinoma
.

From the backline to the frontline, advances in these new treatments will enable cancer patients to live longer and better
.

For more knowledge and literature on immunotherapy, please download the Cancer Degree APP
.

References: Marina Vitorino, Catarina Santos.
Use of Pembrolizumab in End-Stage Renal Disease: A Case Report with Complete Response.
Case Rep Oncol 2022;15:187–190.
Prize Call for Papers Issue 2 [Participation Method] Scan QR code on the poster below to learn about the event details Add @cancer degree official WeChat to participate Click below to learn more about the clinical trial project anti-cancer dry goods review<< Swipe left and right to see more>>