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Case Reports
. 2019 Feb 20;11(2):e4108.
doi: 10.7759/cureus.4108.

Harnessing the Immunomodulatory Effects of Radiation in Urinary Bladder Cancer

Waseem Abbas  1 , Vineeta Goel  2 , Arun Verma  2 , Vineet G Gupta  1 , Ranga R Rao  1
Affiliations
Case Reports

Harnessing the Immunomodulatory Effects of Radiation in Urinary Bladder Cancer

Waseem Abbas et al. Cureus. .

Abstract

The use of local radiation to elicit distant tumor response was proposed long back. The abscopal effect is regression of non-irradiated metastatic lesions at the distant site and there is an enormous therapeutic effect of immunomodulation. Radiation causes cancer cells to release antigens which mount an immune response, but this response is short lasting because cancer cells evade recognition by different mechanisms. Programmed Death Ligand-1 (PDL-1) pathway has been extensively studied. Combining immunotherapy and radiotherapy may result in long-term remissions especially for stage 4 cancer. Here we present a case of high grade urothelial carcinoma that progressed after four cycles of chemotherapy and after giving palliative radiation to urinary bladder he was started on nivolumab. First scan done after radiation and six cycles of nivolumab showed complete response. The patient continues to be in remission for the last 17 months from the start of radiation and immunotherapy that was started sequentially. Overall survival till date is 25 months.

Keywords: abscopal effect of radiation and immunotherapy; immunomodulatory effect of radiation and check point inhibtors in urinary bladder.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Computed tomography (CT) showing bladder cancer involving inferior half of urinary bladder with perivesical extension.
Figure 2
Figure 2. Positron emission tomography (PET) showing bladder cancer involving inferior half of urinary bladder with perivesical extension.
Figure 3
Figure 3. Computed tomography (CT) showing progression in urinary bladder.
Figure 4
Figure 4. Positron emission tomography (PET) showing progression in urinary bladder.
Figure 5
Figure 5. Computed tomography (CT) showing progression in left internal iliac lymph nodes.
Figure 6
Figure 6. Positron emission tomography (PET) showing progression in left internal iliac lymph nodes.
Figure 7
Figure 7. Computed tomography (CT) showing a para-aortic lymph node measuring about 1 cm from where fine needle aspiration cytology (FNAC) was positive for malignant cytology.
Figure 8
Figure 8. Positron emission tomography (PET) showing a para-aortic lymph node measuring about 1 cm from where fine needle aspiration cytology (FNAC) was positive for malignant cytology.
Figure 9
Figure 9. The figure showing radiation planning. Palliative radiation was given to bladder and internal iliac lymph node.
Figure 10
Figure 10. Computed tomography (CT) done after 17 months of starting radiation and immunotherapy showing complete remission in urinary bladder.
Figure 11
Figure 11. Positron emission tomography (PET) done after 17 months of starting radiation and immunotherapy showing complete remission in urinary bladder.
Figure 12
Figure 12. Computed tomography (CT) done after 17 months of starting radiation and immunotherapy showing disease in complete remission and no para-aortic lymph node was seen.
Figure 13
Figure 13. Positron emission tomography (PET) done after 17 months of starting radiation and immunotherapy showing disease in complete remission and no para-aortic lymph node was seen.
See this image and copyright information in PMC

References

    1. Pyroptosis: host cell death and inflammation. Bergsbaken T, Fink SL, Cookson BT. Nat Rev Microbiol. 2009;7:99–109. - PMC - PubMed
    1. Necroptosis: mechanisms and relevance to disease. Galluzzi L, Kepp O, Chan FK, Kroemer G. Annu Rev Pathol. 2017;12:103–130. - PMC - PubMed
    1. Immunogenic cell death in cancer and infectious disease. Galluzzi L, Buqué A, Kepp O, Zitvogel L, Kroemer G. Nat Rev Immunol. 2017;17:97–111. - PubMed
    1. DNA exonuclease Trex1 regulates radiotherapy-induced tumour immunogenicity. Vanpouille-Box C, Alard A, Aryankalayil MJ, et al. Nat Commun. 2017;8:15618. - PMC - PubMed
    1. Systematic review of case reports on the abscopal effect. Abuodeh Y, Venkat P, Kim S. Curr Probl Cancer. 2016;40:25–37. - PubMed

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