Potential synergistic effect of radiotherapy and immune checkpoint inhibitors on advanced bladder cancer: A case report
Background: The combination of immune checkpoint inhibitors and radiotherapy (RT) is emerging as a promising therapeutic approach for advanced bladder cancer. However, clinical evidence of the abscopal effect in this context is still limited. Case presentation: Presented here is a 61-year-old female with high-grade urothelial carcinoma who had initially undergone chemotherapy, followed by treatment with atezolizumab (an anti-programmed death-ligand 1 antibody). Due to disease progression and symptoms, she received palliative RT alongside continued immunotherapy. Post-RT staging scans showed a significant reduction in the size of the bladder mass and a marked improvement in the patient’s quality of life. Although this case did not demonstrate a definite abscopal effect, it underscores the potential benefits of combining immunotherapy and RT. Conclusion: The observed outcomes suggest that this combination can effectively manage advanced bladder cancer, highlighting the need for further research to refine and optimize these treatment strategies.
- Bladder Cancer Treatment; 2023. Available from: https://www.cancer.gov/types/bladder/treatment [Last accessed on 2024 Aug 13].
- Wu L, Zhang Z, Bai M, Yan Y, Yu J, Xu Y. Radiation combined with immune checkpoint inhibitors for unresectable locally advanced non-small cell lung cancer: Synergistic mechanisms, current State, challenges, and orientations. Cell Commun Signal. 2023;21:119. doi: 10.1186/s12964-023-01139-8
- Seiwert TY, Kiess AP. Time to debunk an Urban myth? The “abscopal effect” with radiation and anti-PD-1. J Clin Oncol. 2021;39:1-3. doi: 10.1200/JCO.20.02046
- Sharma P, Allison JP. Immune checkpoint targeting in cancer therapy: Toward combination strategies with curative potential. Cell. 2015;9:205-214. doi: 10.1016/j.cell.2015.03.030
- Rodríguez-Ruiz ME, Vanpouille-Box C, Melero I, Formenti SC, Demaria S. Immunological mechanisms responsible for radiation-induced abscopal effect. Trends Immunol. 2018;39:644-655. doi: 10.1016/j.it.2018.06.001
- Atezolizumab for Treating Locally Advanced or Metastatic Urothelial Carcinoma after Platinum-Containing Chemotherapy. Guidance. NICE; 2024. Available from: https:// www.nice.org.uk/guidance/ta525/chapter/1-recommendations [Last accessed on 2024 Jul 09th]
- Koller KM, Mackley HB, Liu J, et al. Improved survival and complete response rates in patients with advanced melanoma treated with concurrent ipilimumab and radiotherapy versus ipilimumab alone. Cancer Biol Ther. 2017;18(1):36-42. doi: 10.1080/15384047.2016.1264543
- Hietala A, Joutsen J, Vaarala S, Säily M. A rare and complete response to combination therapy with radiation and nivolumab in a patient with metastatic urothelial cancer. BMJ Case Rep. 2022;15(5):e246653. doi: 10.1136/bcr-2021-246653
- Rizzo M, Soares A, Grande E, et al. Radiotherapy plus pembrolizumab for advanced urothelial carcinoma: Results from the ARON-2 real-world study. Sci Rep. 2024;14:19802. doi: 10.1038/s41598-024-70182-3
- Hall E, Hussain SA, Porta N, et al. Chemoradiotherapy in muscle-invasive bladder cancer: 10-yr follow-up of the phase 3 randomised controlled BC2001 trial. Eur Urol. 2022;82(3):273-279. doi: 10.1016/j.eururo.2022.04.017