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Complete response to pembrolizumab in a patient with recurrent and metastatic urothelial bladder carcinoma reflecting coexisting sarcomatoid subtype and glandular differentiation: a case report

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Abstract

In advanced urothelial carcinoma (UC), approximately 20% of patients respond to pembrolizumab, an anti-programmed cell death-1 (PD-1) antibody. Herein, we reported a single case of UC showing coexistence of sarcomatoid subtype and glandular differentiation. Notably, only glandular differentiation was recurrent, probably progressive, and metastatic, which showed complete response to pembrolizumab. An 80-year-old woman presented with hematuria and dysuria, and an intra-vesical tumor was detected on ultrasound. Transurethral resections (TUR) were performed three times. In the first TUR, a sub-pedunculated tumor and a flat lesion were closely but independently located. Pathologically, the sub-pedunculated tumor was an invasive UC, sarcomatoid subtype. Meanwhile, the flat lesion was invasive UC with glandular differentiation. Despite the second and the additional TUR, the tumor was growing and a lymph node metastasis was detected. The third TUR specimen showed UC with glandular differentiation, and a positive PD-L1 expression as well as high density CD8-positive lymphocytic cells infiltration were observed. Pembrolizumab was administered for four courses after terminating the chemotherapy. The CT scan revealed shrinkage of both primary tumor and metastases. Cystectomy and lymph nodes dissection were performed, and no residual carcinoma was detected. The therapeutic effect was regarded as pathological complete response. Pembrolizumab could be effective for special subtype or divergent differentiation of UC, particularly in an event of an ‘immune hot’ tumor.

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Abbreviations

BCG:

Bacillus calmette-guerin

CR:

Complete response

CT:

Computed tomography

DCR:

Disease control rate

GIST:

Gastrointestinal stromal tumor

ICIs:

Immune checkpoint inhibitors

ORR:

Objective response rate

OS:

Overall survival

PD-L1:

Programmed death-ligand 1

PD-1:

Programmed cell death-1

TUR:

Transurethral resection

UC:

Urothelial carcinoma

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Acknowledgements

We are grateful to Yusuke Hosonuma, Koichi Kamada, and Nobuyuki Suzuki for providing technical support. We would like to thank Editage (www.editage.com) for English language editing.

Funding

This work was supported by Internal Grant (No. 21-B-1–03), Saitama Medical University.

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Authors and Affiliations

  1. Department of Pathology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan

    Yu Miyama & Masanori Yasuda

  2. Department of Uro-Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan

    Kent Kanao

  3. Division of Biomedical Sciences, Research Center for Genomic Medicine, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1241, Japan

    Kousuke Uranishi & Masataka Hirasaki

  4. Department of Clinical Cancer Genomics, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1241, Japan

    Masataka Hirasaki

Authors
  1. Yu Miyama
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  2. Kent Kanao
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  3. Kousuke Uranishi
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  4. Masataka Hirasaki
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  5. Masanori Yasuda
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Contributions

YM designed the study. YM and MY evaluated the histological and immunohistochemical findings. KK provided clinical data. KU and MH performed genetic analysis, YM wrote the manuscript, which was approved by all authors.

Corresponding author

Correspondence to Yu Miyama.

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All authors have no conflict of interests to declare.

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The case report has adhered to the relevant ethical guidelines. In addition, informed consent to participate was obtained from this patient. Our institution does not require reviews for case report.

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Miyama, Y., Kanao, K., Uranishi, K. et al. Complete response to pembrolizumab in a patient with recurrent and metastatic urothelial bladder carcinoma reflecting coexisting sarcomatoid subtype and glandular differentiation: a case report. Int Canc Conf J 12, 24–30 (2023). https://doi.org/10.1007/s13691-022-00568-5

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  • DOI: https://doi.org/10.1007/s13691-022-00568-5

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