Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press185710.17650/1726-9776-2024-20-4-104-111CLINICAL NOTESКЛИНИЧЕСКИЕ СЛУЧАИEffectiveness of pembrolizumab in therapy of sarcomatoid variant of metastatic urothelial carcinoma. Clinical caseЭффективность пембролизумаба в терапии саркоматоидного варианта метастатической уротелиальной карциномы. Клинический случайhttps://orcid.org/0000-0003-3468-87589695-5092PolyakovaA. S.ПоляковаА. С.
Russian Federation

Aleksandra S. Polyakova.

5 2nd Botkinskiy Proezd, Moscow 125284

Полякова Александра Сергеевна - врач-онкоуролог ЦАОП ГБУЗ ММНКЦ им. С.П. Боткина ДЗМ.

125284 Москва, 2-й Боткинский пр-д, 5

plkvs46@mail.ruhttps://orcid.org/0000-0002-8887-5789SokolovE. A.СоколовЕ. А.
Russian Federation

5 2nd Botkinskiy Proezd, Moscow 125284; Build. 1, 2/1 Barrikadnaya St., Moscow 125993

125284 Москва, 2-й Боткинский пр-д, 5; 125993 Москва, ул. Баррикадная, 2/1, стр. 1

https://orcid.org/0000-0002-6096-5723PushkarD. Yu.ПушкарьД. Ю.
Russian Federation

5 2nd Botkinskiy Proezd, Moscow 125284; Build. 1, 2/1 Barrikadnaya St., Moscow 125993; 4 Dolgorukovskaya St., Moscow 127006

125284 Москва, 2-й Боткинский пр-д, 5; 125993 Москва, ул. Баррикадная, 2/1, стр. 1; 127006 Москва, ул. Долгоруковская, 4

S.P. Botkin Moscow Multidisciplinary Scientific and Clinical Center, Moscow Healthcare DepartmentГБУЗ г. Москвы «Московский многопрофильный научно-клинический центр им. С.П. Боткина» Департамента здравоохранения г. МосквыRussian Medical Academy of Continuing Professional Education, Ministry of Health of RussiaФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииRussian University of Medicine, Ministry of Health of RussiaФГБОУ ВО «Российский университет медицины» Минздрава России0112202420410411117102024280120252024https://oncourology.abvpress.ru/oncur/article/view/1857

Sarcomatoid variant of urothelial carcinoma is a rare histological subtype: it is diagnosed in 0.1–0.3 % of all neoplasms of the bladder. The standard 1st line therapy for all types of advanced urothelial carcinoma is chemotherapy which does not necessarily allow to achieve the best or complete responses, especially in the presence of sarcomatoid differentiation. High programmed cell death-ligand 1 (PD-L1) expression in this morphological subtype allows to assume better results of immunotherapy compared to chemotherapy. However, a large number of observations is necessary to confirm this hypothesis and suggest pembrolizumab immunotherapy as a standard 1st line therapy for metastatic urothelial carcinoma with sarcomatoid differentiation.

Саркоматоидный вариант уротелиальной карциномы является редким гистологическим подтипом – частота его обнаружения составляет около 0,1–0,3 % всех новообразований мочевого пузыря. Стандартом 1-й линии в лечении распространенного уротелиального рака всех подтипов является химиотерапия, которая не всегда позволяет достичь наилучшего и полного ответа, особенно при наличии саркоматоидной дифференцировки. Высокая экспрессия лиганда белка программируемой гибели клеток 1 (programmed cell death-ligand 1, PD-L1) при данном морфологическом подтипе опухоли позволяет рассчитывать на лучшие результаты иммунотерапии в сравнении с химиотерапией. Однако необходимо большее количество наблюдений для подтверждения данного тезиса и предложения иммунотерапии пембролизумабом в качестве стандарта 1-й линии метастатической уротелиальной карциномы с саркоматоидной дифференцировкой.

urothelial carcinomabladder cancerimmunotherapypembrolizumabsarcomatoid carcinomaуротелиальный ракрак мочевого пузыряиммунотерапияпембролизумабсаркоматоидный рак1. Lenis A.T., Lec P.M., Chamie K., Mshs M.D. Bladder cancer: a review. JAMA 2020;324(19):1980–91. DOI: 10.1001/jama.2020.17598Lenis A.T., Lec P.M., Chamie K., Mshs M.D. Bladder cancer: a review. JAMA 2020;324(19):1980–91. DOI: 10.1001/jama.2020.175982. Gu L., Ai Q., Cheng Q. et al. Sarcomatoid variant urothelial carcinoma of the bladder: a systematic review and meta­analysis of the clinicopathological features and survival outcomes. Cancer Cell Int 2020;20(1):550. DOI: 10.1186/s12935­020­01626­9Gu L., Ai Q., Cheng Q. et al. Sarcomatoid variant urothelial carcinoma of the bladder: a systematic review and meta­analysis of the clinicopathological features and survival outcomes. Cancer Cell Int 2020;20(1):550. DOI: 10.1186/s12935­020­01626­93. Sui W., Matulay J.T., Onyeji I.C. et al. Contemporary treatment patterns and outcomes of sarcomatoid bladder cancer. World J Urol 2017;35(7):1055–61. DOI: 10.1007/s00345­016­1962­8Sui W., Matulay J.T., Onyeji I.C. et al. Contemporary treatment patterns and outcomes of sarcomatoid bladder cancer. World J Urol 2017;35(7):1055–61. DOI: 10.1007/s00345­016­1962­84. Konala V.M., Adapa S., Aronow W.S. Immunotherapy in bladder cancer. Am J Ther 2022;29(3):e334–7. DOI: 10.1097/MJT.0000000000000934Konala V.M., Adapa S., Aronow W.S. Immunotherapy in bladder cancer. Am J Ther 2022;29(3):e334–7. DOI: 10.1097/MJT.00000000000009345. Evans S.T., Jani Y., Jansen C.S. et al. Understanding and overcoming resistance to immunotherapy in genitourinary cancers. Cancer Biol Ther 2024;25(1):2342599. DOI: 10.1080/15384047.2024.2342599Evans S.T., Jani Y., Jansen C.S. et al. Understanding and overcoming resistance to immunotherapy in genitourinary cancers. Cancer Biol Ther 2024;25(1):2342599. DOI: 10.1080/15384047.2024.23425996. Bellmunt J., de Wit R., Vaughn D.J. et al. Pembrolizumab as second­ line line therapy for advanced urothelial carcinoma. N Engl J Med 2017;376(11):1015–26. DOI: 10.1056/NEJMoa1613683Bellmunt J., de Wit R., Vaughn D.J. et al. Pembrolizumab as second­ line line therapy for advanced urothelial carcinoma. N Engl J Med 2017;376(11):1015–26. DOI: 10.1056/NEJMoa16136837. Miller N.J., Khaki A.R., Diamantopoulos L.N. et al. Histological subtypes and response to PD­1/PD­L1 blockade in advanced urothelial cancer: a retrospective Study. J Urol 2020;204(1):63–70. DOI: 10.1097/JU.0000000000000761Miller N.J., Khaki A.R., Diamantopoulos L.N. et al. Histological subtypes and response to PD­1/PD­L1 blockade in advanced urothelial cancer: a retrospective Study. J Urol 2020;204(1):63–70. DOI: 10.1097/JU.00000000000007618. Kobayashi T., Ito K., Kojima T. et al.; Japan Urological Oncology Group. Risk stratification for the prognosis of patients with chemoresistant urothelial cancer treated with pembrolizumab. Cancer Sci 2021;112(2):760–73. DOI: 10.1111/cas.14762Kobayashi T., Ito K., Kojima T. et al.; Japan Urological Oncology Group. Risk stratification for the prognosis of patients with chemoresistant urothelial cancer treated with pembrolizumab. Cancer Sci 2021;112(2):760–73. DOI: 10.1111/cas.147629. Iacovelli R., Ciccarese C., Bria E. et al. Patients with sarcomatoid renal cell carcinoma – re­defining the first­line of treatment: a meta­analysis of randomised clinical trials with immune checkpoint inhibitors. Eur J Cancer 2020;136:195–203. DOI: 10.1016/j.ejca.2020.06.008Iacovelli R., Ciccarese C., Bria E. et al. Patients with sarcomatoid renal cell carcinoma – re­defining the first­line of treatment: a meta­analysis of randomised clinical trials with immune checkpoint inhibitors. Eur J Cancer 2020;136:195–203. DOI: 10.1016/j.ejca.2020.06.00810. Kotlowska M.P., Rueda A.G., Olmedo M.E. et al. Efficacy of immunotherapy in sarcomatoid lung cancer, a case report and literature review. Respir Med Case Rep 2019;26:310–4. DOI: 10.1016/j.rmcr.2019.02.017Kotlowska M.P., Rueda A.G., Olmedo M.E. et al. Efficacy of immunotherapy in sarcomatoid lung cancer, a case report and literature review. Respir Med Case Rep 2019;26:310–4. DOI: 10.1016/j.rmcr.2019.02.01711. Tsurumi K., Kawashima Y., Akahira J. et al. A remarkable clinical response to pembrolizumab in a rare spindle cell carcinoma of the lung. JMA J 2020;3(1):83–6. DOI: 10.31662/jmaj.2019­0015Tsurumi K., Kawashima Y., Akahira J. et al. A remarkable clinical response to pembrolizumab in a rare spindle cell carcinoma of the lung. JMA J 2020;3(1):83–6. DOI: 10.31662/jmaj.2019­001512. Jin C., Yang B. Dramatic response of pulmonary sarcomatoid carcinoma to nivolumab combined with anlotinib: a case report. Case Rep Oncol 2020;13(2):601–5. DOI: 10.1159/000507568Jin C., Yang B. Dramatic response of pulmonary sarcomatoid carcinoma to nivolumab combined with anlotinib: a case report. Case Rep Oncol 2020;13(2):601–5. DOI: 10.1159/00050756813. Li H., Zhang Q., Shuman L. et al. Evaluation of PD­L1 and other immune markers in bladder urothelial carcinoma stratified by histologic variants and molecular subtypes. Sci Rep 2020;10(1):1439. DOI: 10.1038/s41598­020­58351­6Li H., Zhang Q., Shuman L. et al. Evaluation of PD­L1 and other immune markers in bladder urothelial carcinoma stratified by histologic variants and molecular subtypes. Sci Rep 2020;10(1):1439. DOI: 10.1038/s41598­020­58351­614. Murase K., Nakane K., Kawase M. et al. Metastatic urothelial carcinoma with sarcomatoid subtype after robot­assisted radical cystectomy successfully treated with pembrolizumab. Cureus 2024;16(6):e61871. DOI: 10.7759/cureus.61871Murase K., Nakane K., Kawase M. et al. Metastatic urothelial carcinoma with sarcomatoid subtype after robot­assisted radical cystectomy successfully treated with pembrolizumab. Cureus 2024;16(6):e61871. DOI: 10.7759/cureus.61871