Pseudoprogression or unexpected favorable response to third-line therapy: a challenging metastatic bladder cancer case

摘要

Bladder cancer is the first most common urologic malignancy in adults and it is highly lethal in the metastatic setting.1 The incidence rate is approximately 3 times higher in men than in women. The most well-established risk factor for urothelial carcinogenesis is cigarette smoking.2 Approximately 10% to 20% of patients with invasive urothelial cancers present with metastatic disease at diagnosis and another 20% to 70% will subsequently develop it after definitive treatment of the invasive primary tumor, depending on the stage and lymph node status.3 The most frequent sites of metastization are the pelvic region, bone, lymph nodes, and lung. The presence of bone or liver metastasis and poor performance status (PS) are predictive of poor response and survival. Platin-containing combination chemotherapy is the standard approach for the initial treatment of patients with metastatic urothelial malignancy.4 In second-line single agent paclitaxel and docetaxel are commonly used worldwide and in Europe,5,6 and vinflunine has been approved on the basis of an overall survival (OS) advantage of 2 months over best supportive care.7 Nowadays, immune checkpoint inhibitors offers an additional option for patients progressing after their initial systemic therapy or when the patients are not eligible for platinum.