Case Report: Neoadjuvant immunotherapy with pembrolizumab alone for bilateral upper tract urothelial carcinoma is a feasible strategy for kidney sparing and avoidance of hemodialysis

Wai Nga Chan, Yun Ching Huang, Dong Ru Ho, Chih-Shou Chen*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

Abstract

In Taiwan, the incidence of upper-tract urothelial carcinomas (UTUCs) is higher than in western countries (20%–31% vs. 5%–10%), as is bilateral disease. The standard management for high-grade UTUC is radical nephroureterectomy with bladder cuff excision and regional lymphadenectomy. The challenges in managing bilateral UTUCs are how to retain renal function and avoid permanent hemodialysis. We present two cases of developed bilateral high-grade renal pelvis urothelial carcinoma, cT3N0M0 stage III, that revealed excellent results in tumor regression after three cycles of half-dose pembrolizumab. One case received unilateral retroperitoneal laparoscopic nephroureterectomy with bladder cuff excision; thereafter, renal function has been good until now, and the remaining right kidney has been free of tumor recurrence in the 3 years of follow-up. The other patient, however, expired from an immune-related adverse event (irAE) 22 days after the third cycle of pembrolizumab, although tumor remission was evident also. Neoadjuvant pembrolizumab alone could be a potential strategy in positive of selected biomarkers for high-grade bilateral UTUC with remaining neglectable nephrotoxicity and may avoid permanent hemodialysis.

Original languageEnglish
Article number985177
JournalFrontiers in Oncology
Volume12
DOIs
StatePublished - 23 09 2022
Externally publishedYes

Bibliographical note

Publisher Copyright:
Copyright © 2022 Chan, Huang, Ho and Chen.

Keywords

  • case report
  • immune checkpoint inhibitors
  • kidney sparing
  • neoadjuvant immunotherapy
  • upper tract urothelial carcinoma

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