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Case Reports
. 2021 Jul 20;4(6):360-362.
doi: 10.1002/iju5.12348. eCollection 2021 Nov.

Successful treatment of metastatic bladder cancer by gemcitabine-cisplatin re-challenge after pembrolizumab

Takayuki Arai  1 , Nobuyoshi Takeuchi  1 , Tomokazu Sazuka  1 , Hiroaki Sato  1 , Yusuke Imamura  1 , Shinichi Sakamoto  1 , Akira Komiya  1 , Tomohiko Ichikawa  1
Affiliations
Case Reports

Successful treatment of metastatic bladder cancer by gemcitabine-cisplatin re-challenge after pembrolizumab

Takayuki Arai et al. IJU Case Rep. .

Abstract

Introduction: The advent of pembrolizumab has contributed to improved treatment outcomes for metastatic urothelial carcinoma, but the outcomes of treatments after second-line treatment have not been established.

Case presentation: A 72-year-old man was referred to our hospital with gross hematuria and diagnosed with suspicion of bladder cancer cT1N0M0. Transurethral resection of the bladder tumor was performed, but local recurrence and multiple lung metastases appeared 5 months after surgery. Although gemcitabine-cisplatin was performed as first-line chemotherapy, the local lesion increased, and pembrolizumab was used as a second-line treatment. Pembrolizumab was also ineffective; however, re-challenge with gemcitabine-cisplatin as third-line treatment produced a good therapeutic effect.

Conclusion: We report a successful case in which gemcitabine-cisplatin re-challenge after pembrolizumab therapy was effective in metastatic bladder cancer. Re-administration of chemotherapy after immune checkpoint inhibitors may be a broadly effective treatment option.

Keywords: gemcitabine‐cisplatin re‐challenge; metastatic urothelial carcinoma; pembrolizumab.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Image diagnosis at the first visit. (a) Cystoscopic findings: A 50‐mm papillary tumor extended from the bladder neck to the left wall. (b) MRI findings: A bladder tumor with no positive indication of muscular invasion was found on the left wall of the bladder.
Fig. 2
Fig. 2
Treatment course after the appearance of lung metastases by CT evaluation. (a) Findings before the start of treatment. Multiple lung metastases and local recurrence are observed (eGFR = 75.7ml/min/1.73m2). (b) Findings after two courses of first GC. Multiple lung metastases did not change significantly, but local recurrence progressed. As shown by the yellow arrow, the left hydroureter was newly confirmed (eGFR = 65.4ml/min/1.73m2). (c) Findings after four courses of pembrolizumab. Multiple lung metastases were markedly increased (eGFR = 69.7ml/min/1.73m2). (d) Findings after one course of re‐challenge GC. Multiple lung metastases were significantly reduced, while local recurrence was unchanged (eGFR = 73.6ml/min/1.73m2). (e) Findings after three courses of re‐challenge GC. Multiple lung metastases were further reduced (eGFR = 73.3ml/min/1.73m2).
See this image and copyright information in PMC

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