Development of secondary urothelial carcinoma following complete response to immune checkpoint inhibitors

• Main Authors: Jean-Michel Lavoie, Gillian Vandekerkhove, Andrew J. Murtha, Gang Wang, Alexander W. Wyatt, Bernhard J. Eigl
• Format: Article
• Language: English
• Published: Elsevier 2021-11-01
• Series: Urology Case Reports
• Subjects: Urothelial cancer; Checkpoint inhibitor; Next-generation sequencing
• Online Access: http://www.sciencedirect.com/science/article/pii/S2214442021002023

The management of metastatic urothelial cancer is rapidly evolving since immune checkpoint inhibitors were introduced. We present the case of a patient with metastatic upper tract urothelial cancer who had a complete response to durvalumab and tremelimumab. This patient then developed multiple non-invasive papillary bladder tumours. Next-generation sequencing revealed that the tumours shared ancestry with the upper tract cancer, although there were key differences, most notably the presence of a TP53 missense mutation in the upper tract disease that was absent in the bladder tumours. This illustrates an important practice point in the management of exceptional responders to checkpoint inhibitors.