Maintenance avelumab therapy for urothelial carcinoma in a hemodialysis patient: a case report.

In recent years, immune checkpoint inhibitors have attracted attention in treatment for urothelial carcinoma. However, many clinical trials included only patients who had adequate renal function. The efficacy of immune checkpoint inhibitors for hemodialysis patients had not been well-documented. Herein, we report a case of a 73-years-old male with metastatic urothelial carcinoma. He was on maintenance hemodialysis, because he underwent total urinary tract resection for treatment of the urothelial carcinoma in his sixties. He was introduced to our hospital with metastases of lung and pubic bone, and was treated with chemotherapy including gemcitabine and paclitaxel. After two cycles, although his metastases decreased in size, he experienced severe anemia, diarrhea, and duodenitis. Therefore, he transitioned to maintenance therapy with avelumab earlier than initially planned. The treatment achieved 10 months disease control, without significant adverse events. To our best knowledge, this is the first case in which avelumab maintenance therapy achieved disease control of metastatic urothelial carcinoma in a hemodialysis patient.

Syndrome of inappropriate secretion of antidiuretic hormone associated with angiotensin-converting enzyme inhibitor therapy in the perioperative period.

INTRODUCTION:: Angiotensin-converting enzyme (ACE) inhibitors are one of the most commonly used medications for hypertension. Rarely, ACE inhibitors have the potential to cause a syndrome of inappropriate secretion of antidiuretic hormone (SIADH). CASE PRESENTATION:: A 70-year-old woman with > 10 years ACE inhibitor therapy with normonatremia suddenly developed severe SIADH when she took a liquid diet in the uneventful perioperative period, with hemodynamic stability and no surgical complications. She promptly recovered from SIADH subsequent to discontinuing the ACE inhibitor therapy and changing her diet. Therefore, it was assumed that excess antidiuretic hormone secretion due to an ACE inhibitor and free water load from the liquid diet contributed to hyponatremia in our patient. CONCLUSION:: Patients treated with an ACE inhibitor can latently experience inappropriate secretion of antidiuretic hormone, and rapidly develop severe hyponatremia together with additional factors affecting water or salt homeostasis regardless of the length of the administration duration. Clinicians should monitor serum sodium levels in such patients not only just after the initiation of ACE inhibitors but also upon the appearance of those factors.