A case of complete response following the administration of pembrolizumab and metastasectomy for lung and bone metastases of bladder cancer

Abstract

Introduction Patients with metastatic urothelial carcinoma have poor prognosis and limited treatment options. Case presentation The patient was a 60‐year‐old male with bladder cancer and multiple lung metastases. He underwent three courses of gemcitabine and cisplatin chemotherapy, despite left femoral bone metastases. Tumor resection and bone replacement surgery was performed. Following the administration of four courses of pembrolizumab, lung metastasis completely resolved. However, after nine courses, right femoral neck bone metastasis was observed; therefore, tumor resection and bone replacement surgery were repeated. Pathologically, PD‐L1 expression was low in lung biopsy tissue and bone metastases. Pembrolizumab treatment continued for up to 20 courses; cancer recurrence and adverse events were not observed upon follow‐up examination after 1 year. Conclusion Patients responding well to systemic therapy may have resectable metastatic sites, and long‐term survival might be achieved with adjunctive metastasectomy. The effect of pembrolizumab was not associated with positive PD‐L1 expression.

Is there a role for metastasis-directed therapy in bladder cancer?

“…Table 1 provides an overview of the studies meeting our inclusion criteria, encompassing eight studies investigating MDT in BCa patients. These studies comprise three case reports [11][12][13], and five retrospective observational studies [14 & ,15,16,17…”

“…Table 1 provides an overview of the studies meeting our inclusion criteria, encompassing eight studies investigating MDT in BCa patients. These studies comprise three case reports [11–13], and five retrospective observational studies [14 ▪ ,15,16,17 ▪▪ ,18 ▪ ], all published within the last 2 years. Table 2 summarizes the oncological outcomes of MDT across the retrospective studies.…”

“…Recently, Park et al [12] described a case of metastatic BCa to the pancreatic head, where pancreaticoduodenectomy followed by adjuvant gemcitabine and cisplatin resulted in 16 months of tumor-free survival. Another case by Nakasato et al [13] involved bilateral femoral neck metastasectomy, followed by pembrolizumab and achieving 2 years and 11 months of recurrence-free survival. These cases underscore the potential synergy between systemic immunotherapy, chemotherapy, and metastasectomy in the management of OMBC.…”

“…Data from [11–13,14 ▪ ,15,16,17 ▪▪ ,18 ▪ ,38–42]. AE, adverse events; BC, bladder cancer; DLTs, dose limiting toxicities; DOR, duration of response; DSS, disease-specific survival; HNCs, head and neck cancers; LC, local control; MDT, metastasis-directed therapy; MIBC, muscle invasive bladder cancer; mUBC, metastatic urothelial carcinoma of the bladder; NPD, nonprogression duration; NSCLC, nonsmall cell lung cancer; OMD, oligometastatic disease; ORR, objective response rate; OS, overall survival; pCR, pathologic complete response rate; PFS, progression free survival; QOL, quality of life; RCC, renal cell carcinoma; SBRT, stereotactic body radiation therapy; SOC, standard of care; TTP, time to progression; TURBT, transurethral resection of bladder tumor.…”

Cold atmospheric plasma: Novel opportunities for tumor microenvironment targeting

“…Several onco‐therapeutics of this kind have been made commercially available. For instance, pembrolizumab (PD1 antibody) was shown effective in treating many types of malignancies such as triple negative breast cancers, 66 cervical cancers, 67 prostate cancers, 68 gastric cancers, 69,70 esophageal cancers, 71 gastroesophageal junction cancers, 70 bladder cancers, 72 pancreatic cancers, 73 non‐small lung cancers, 74,75 melanomas, 75 head and neck cancers, 76 endometrial cancers, 77 colorectal cancers, 78 urothelial cancers 79 ; and was approved by the USA Food and Drug Administration (FDA) for treating tumor mutational burden‐high solid tumors, 80 microsatellite instability‐high solid tumors, 81 advanced urothelial carcinomas ineligible for cisplatin‐containing chemotherapy, 82 recurrent or metastatic head and neck squamous cell carcinomas with disease progression on or after platinum‐containing chemotherapies, 83 recurrent locally advanced or metastatic merkel cell carcinomas, 84 recurrent locally advanced or metastatic gastric or gastroesophageal junction adenocarcinomas expressing PD‐L1, 85 cervical cancers expressing PD‐L1, 86 BCG‐unresponsive non‐muscle invasive bladder cancers, 87 metastatic non‐small cell lung cancers expressing PD‐L1 (as a first‐line therapy), 88–90 MSI‐H/dMMR advanced unresectable or metastatic colorectal carcinomas (as a first‐line therapy), 91 metastatic melanomas (as a second‐line therapy), 92 and locally recurrent unresectable or metastatic triple negative breast cancers through combined use with chemotherapies 93 . As an example of PD‐L1 antibodies, nivolumab was shown effective for treating recurrent squamous‐cell carcinomas of the head and neck, 94,95 advanced renal‐cell carcinomas, 96 metastatic melanomas, 97 advanced squamous‐cell non‐small cell lung cancers 98 ; and was approved by FDA in the treatment of relapsed or progressive classical Hodgkin lymphomas, 99 advanced renal cell carcinomas, 100 metastatic non‐small cell lung cancers with progression on or after platinum‐based chemotherapies, 101 bladder cancers, 102 BRAF(V600) wild‐type unresectable or metastatic melanomas (as a first‐line therapy), 103 ad...…”