Bladder Cancer Coverage from Every Angle

Case Report: Older Woman With Metastatic Bladder Cancer Responds to Pembrolizumab

By: Vanessa A. Carter, BS
Posted: Monday, October 11, 2021

Michael Maroules, MD, of Saint Joseph’s University Medical Center, Paterson, New Jersey, and colleagues presented a case study in the Journal of Investigative Case Reports featuring a complete response to the immune checkpoint inhibitor pembrolizumab in an older patient with metastatic bladder cancer who was ineligible for chemotherapy. These investigators explained that although platinum-based chemotherapy remains the first-line treatment of bladder cancer, the administration of pembrolizumab has often achieved complete responses in individuals with various malignancies.

An 83-year-old woman presented to the emergency department with lower abdominal pain, beginning 1 month prior that progressively had become worse. A CT scan of the pelvis and abdomen uncovered a large hydroureter, hydronephrosis mass in the base of the bladder, along with a 4.6 cm x 4.7 cm mass in the middle of the left common femoral artery. A transurethral resection of the tumor revealed a large necrotic mass on the left side of the bladder, which was identified as high-grade metastatic urothelial carcinoma.

The patient’s eligibility for chemotherapy was hindered due to her performance status and age, so pembrolizumab was initiated. The woman received seven cycles of pembrolizumab every 3 weeks but eventually presented with difficulty breathing, and a chest CT scan revealed pneumonitis. The patient permanently stopped pembrolizumab and began steroids, later being discharged home.

The woman continued her follow-up as an outpatient off therapy and repeated abdomen, chest, and pelvis CT scans 6 months after the last treatment dose. At this time, the patient showed no evidence of metastatic disease in her abdomen, chest, or pelvis, suggesting a complete response to pembrolizumab.

Disclosure: The study authors reported no conflicts of interest.

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