YO15 - Concurrent Atezolizumab-Radiotherapy in Locally Recurrent Urinary Bladder Carcinoma: A Case Report

Case summary

Concurrent Atezolizumab-Radiotherapy in Locally Recurrent Urinary Bladder Carcinoma: A Case Report

Abstract

Locally recurrent urinary bladder carcinoma is difficult to manage and cytotoxic chemotherapy regimens offer low response rates with high toxicities. Immune checkpoint inhibitors represent new opportunity for effective management of these patients. Atezolizumab produced durable responses, improved survival and tolerability in cisplatin-ineligible patients with locally advanced or metastatic urothelial carcinoma. High-dose radiation, in addition to its direct cell killing, could influence immune response. Combination of immune checkpoint inhibitor and radiation therapy have the potential to provide a synergistic effect in treating GU malignancies. This is a case of locally recurrent urinary bladder carcinoma responding to Atezolizumab plus radiotherapy.

A 66 year old male had 2 months history gross hematuria. Pelvic MRI showed a left-sided 3.4 x 2.4 x 2.8 cm urinary bladder tumor. A transurethral resection of bladder tumor (TURBT) was done and histopathology revealed high-grade urothelial carcinoma with glandular metaplasia and invasion of the lamina propria. The patient had a prolonged hospitalization due to subsequent emergency exploratory laparotomy secondary to ruptured peptic ulcer disease complicated by wound dehiscence and hospital-acquired pneumonia. 5 months from TURBT, re-evaluation KUB ultrasound showed mucosal irregularity (1.6 x 1.6 x 1.3 cm) in left side of Urinary bladder with a hypoechoic mass adjacent to it. Patient refused further work-up. At this time, he was also being treated for recurrent parapneumonic effusion. Radical cystectomy was contemplated but due to the patient’s condition the patient was deemed inoperable. Moreover, the patient refused cytotoxic chemotherapy. He thus underwent IMRT to 60 cGy concurrent with Atezolizumab 1200 mg IV every 21 days for 12 cycles. CT evaluation showed no residual or recurrent tumor. The patient remains to be asymptomatic with weight gain and on close surveillance.

Clinical trial identification

Editorial acknowledgement