Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2023; 11(28): 6841-6849
Published online Oct 6, 2023. doi: 10.12998/wjcc.v11.i28.6841
Hyperprogression after anti-programmed death-1 therapy in a patient with urothelial bladder carcinoma: A case report
Hong-Yu Yang, Yu-Xuan Du, Yu-Jia Hou, Dian-Rong Lu, Peng Xue
Hong-Yu Yang, Yu-Jia Hou, Dian-Rong Lu, Peng Xue, Department of Oncology, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100000, China
Hong-Yu Yang, Department of Oncology, Tianjin University of Chinese Medicine, Tianjin 300000, China
Yu-Xuan Du, Traditional Chinese Medical Science, Tianjin University of Chinese Medicine, Tianjin 300000, China
Author contributions: Yang HY drafted the manuscript; Du YX and Hou YJ reviewed the literature and participated in drafting the manuscript; Xue P and Lu DR revised the manuscript for important intellectual content; and all authors have approved the final manuscript.
Supported by the National Natural Science Foundation, No. 81973640.
Informed consent statement: Informed written consent was obtained from the patients for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dian-Rong Lu, Doctor, PhD, Chief Physician, Professor, Department of Oncology, Wangjing Hospital, China Academy of Chinese Medical Sciences, No. 6 Huajiadi Street, Chaoyang District, Beijing 100000, China. ludianrong@aliyun.com
Received: June 22, 2023
Peer-review started: June 22, 2023
First decision: August 8, 2023
Revised: August 22, 2023
Accepted: September 4, 2023
Article in press: September 4, 2023
Published online: October 6, 2023
Processing time: 95 Days and 6 Hours
Abstract
BACKGROUND

Immune checkpoint inhibitors, including programmed death-ligand 1 (PD-L1) and programmed death-1 (PD-1) have recently been approved to treat locally advanced and metastatic urothelial carcinoma (UC). However, some patients experience rapid tumor progression rather than any clinical benefit from anti-PD-L1/PD-1 therapy.

CASE SUMMARY

A 73-year-old woman with bladder UC showed the progression of multiple metastases after surgery and chemotherapy for over 12 mo. The patient could not tolerate further chemotherapy. Next-generation sequencing was performed, and the results indicated that the tumor mutational burden was 6.4 mutations/Mb. The patient received the anti-PD-L1 agent toripalimab combined with albumin-bound paclitaxel. Compared with the baseline staging before immunotherapy, the patient had a treatment failure time of < 2 mo, an increase in tumor burden of > 50%, and a > 2-fold increase in progression, indicating hyperprogression.

CONCLUSION

Selecting patients most likely to respond to treatment with immunotherapeutic agents remains challenging. For older patients with advanced UC who have already exhausted multi-line chemotherapy options, immunotherapy should be used prudently if no effective biomarker is available. Further studies are required to clarify the causes and mechanisms of hyperprogression.

Keywords: Bladder urothelial carcinoma, Hyperprogression, Immunotherapy, Toripalimab, Case report

Core Tip: We report a patient with bladder urothelial carcinoma (UC) who received anti- programmed death-ligand 1 agent toripalimab after surgery and chemotherapy over 12 mo had a treatment failure time less than 2 mo and showed a hyperprogression. Currently, it is still a challenge to select the patients most likely to respond to treatment with immunotherapeutic agents. For elderly patients with advanced UC, immunotherapy should be used prudently if there is no clear effective biomarker. In this case presentation, we include information on genetic alterations. With continued clinical trials and basic research, the risk factors for immunotherapy-related hyperprogressive disease will become clearer.