Evaluation of predictive factors in patients with bladder cancer undergoing atezolizumab treatment: Case reports.

This series consists of three cases. Clinical features and pathological characteristics, expression of tumor-infiltrating lymphocytes (TIL), TIL-PD-L1 expression, microsatellite instability (MSI), and programmed death-ligand (PD-L1) were evaluated for predicting response to immunotherapy in patients receiving atezolizumab for advanced bladder cancer. Tumor PDL-1 level was 80% in case 1; however, PDL-1 level was detected as 0% in other cases. TIL PDL-1 level was 5% in the first case, and 1% and 0% in the second and third cases, respectively. TIL density was higher in the first case than in the other two cases. MSI was not detected in any of the cases. With atezolizumab treatment, the radiologic response was obtained only in the first case and progression free survival (PFS) lasting 8 months was detected. In the other two cases, there was no response with atezolizumab and the disease progressed. When the clinical factors (performance status, hemoglobin level, presence of liver metastases, and response time to platinum regimen) predicting the response to the second series of treatments were evaluated, patients had a risk factor of 0, 2, and 3, respectively. The overall survival of the cases was determined as 28, 11, and 11 months, respectively. In our study, when compared with the other cases, the first case reported a higher PD-L1, higher TIL PD-L1 level, higher TIL density, and low clinical risk factors and had longer survival with atezolizumab.

Safe use of nivolumab in a patient with renal cell carcinoma and hepatitis B.

INTRODUCTION: Immunotherapy with checkpoint inhibitors gains a major role in bladder cancer. Because of the treatment's immune modulatory effects, patients may develop hepatitis. Hepatitis B was an exclusion criterion in clinical trials that investigated nivolumab. Therefore, its effects and risk of hepatitis B reactivation in nivolumab are not clinically investigated in renal cell carcinoma patients with hepatitis B. CASE REPORT: In this case report, we presented a metastatic renal cell carcinoma patient who was treated with anti-viral treatment for hepatitis reactivation caused by previous sunitinib therapy. After progression, nivolumab was commenced and the patient was closely monitored with hepatic function tests. MANAGEMENT AND OUTCOME: Nivolumab was well tolerated and no treatment-related adverse effect occurred. Hepatitis or viral hepatitis reactivation was not detected. DISCUSSION: This case supports the safety of nivolumab in patients with renal cell carcinoma and viral hepatitis.

Comparison of preoperative locoregional Ga-68 PSMA-11 PET-CT and mp-MRI results with postoperative histopathology of prostate cancer.

BACKGROUND: Conventional imaging modalities are inadequate to evaluate locoregional extension of prostate cancer (PCa). The aim of the current retrospective study was to investigate the diagnostic efficacy of Gallium-68 prostate-specific membrane antigen-11 (Ga-68 PSMA-11) positron emission tomography/computed tomography (PET/CT) and multiparametric magnetic resonance imaging (mp-MRI) for staging preoperative PCa patients with correlating histopathology. MATERIALS AND METHODS: Twenty-four patients with histologically proven PCa underwent both Ga-68 PSMA-11 PET/CT and mp-MRI before robot-assisted laparoscopic radical prostatectomy. For each tumor area, correlations with histopathological results were defined for tumor localization, extraprostatic extension (EPE) of the tumor, invasion of seminal vesicle (SVI) and bladder neck invasion (BNI). In patients with regional lymph node (LN) dissection, histopathological results were also correlated with imaging modalities. RESULTS: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for detection of EPE and SVI were higher for mp-MRI than Ga-68 PSMA-11 PET/CT. On the other hand Ga-68 PSMA-11 PET/CT had significant successful results for detection of LN metastases when compared with mp-MRI. But for BNI detection both modalities had same insufficient results. Ga-68 PSMA-11 PET/CT had strong results for appropriate tumor localization in the gland. CONCLUSION: Ga-68 PSMA PET/CT has superior results for assessing local LN metastases and for intraprostatic tumor localization. Whereas, mp-MRI must be the preferred modality for determining SVI and EPE. But both imaging modalities failed for determining BNI accurately. Both modalities should be used in conjunction with each other for better treatment planning.