Introduction
Inhibition of programmed death receptor-1 (PD-1)/PD-L1 checkpoint has demonstrated significant benefit in patients with unresectable and metastatic Bladder Cancer for first-line treatment in cisplatin-unfit patients in case of positive PD-L1 status. Data have been presented with encouraging results, showing that using the PD-1 inhibitor pembrolizumab reported a complete pathological remission (pT0) in 42% and pathological response (< pT2) in 54% of patients.
Case report
A 72-year-old male presented with acute bilateral obstructive uropathy, haematuria and abdominal pain. A CT-Urogram was performed, manifesting left ureteral rupture and bladder wall enlargement. Bilateral nephrostomy and a bladder-prostate transurethral resection (TURBT + TURP) were performed, showing bladder tumour with prostate and left ureteral invasion. Tissue analysis exhibited high grade urothelial carcinoma PD-L1 positive. Following the surgery, disease was updated with Thorax-Abdomen-Pelvis CT-scan, observing retroperitoneal lymph node invasion. After urinary diversion with bilateral nephrostomy, patient persisted with GFR< 30 ml/min, so after discussing the case in a multidisciplinary team, it was decided to start a treatment with Pembrolizumab. Following 8 Pembrolizumab-cycles Thorax-Abdomen-Pelvis CT-scan was repeated, showing response, so our multidisciplinary team proposed radical cystectomy + lymphadenectomy and Bricker urinary diversion. Surgical piece was analyzed, exhibiting absence of tumour (pT0 N0). During the next 17-months follow-up, Thorax-Abdomen-Pelvis CT-scan have not shown tumour relapse or metastasis.
Conclusions
Immunotherapy is a promising therapy in the treatment of urothelial cancer for patients unfit for chemotherapy, showing pathological remission in 30-40% of patients, therefore it is a key-point for those who are not able to benefit from first line therapies.

Pembrolizumab: complete pathological remission in metastatic bladder cancer. A case report

For 2021, our focus remains: turning new data into your daily practice. The programme will consist of state-of-the-art lectures, case discussions and panel debates. Our faculty is a group of international & multidisciplinary experts.

We will take you on our journey to Ghent and beyond. Prior the congress, we send out case challenges, where you can compare your opinion with peers & experts. These cases will be part of the Global Congresses on Prostate & Bladder Cancer programme during the congress days (12 & 13 October for PROSCA and 14 & 15 October for BLADDR). After these days, you will be updated on prostate & bladder cancer management.