Modern possibilities of drug therapy of widespread urothelial carcinoma of the bladder (clinical case)

Abstract

Relevance. The standard treatment for patients with advanced urothelial carcinoma (AUC) is platinum-based chemotherapy, but progression-free survival and overall survival are limited by chemotherapy resistance. Study objective. To demonstrate current drug therapy options in a patient with AUC. Materials and methods. The abstract describes a clinical case of a 62-year-old male patient with a diagnosis of "C-r of the bladder St IIIA T1N1M0, MTS-lesion of the pelvic lymph nodes on the right, bilateral ureterohydronephrosis, condition after bilateral nephrostomy". Morphological form: urothelial carcinoma G2 with invasion into the submucosa. The treatment outcome was assessed according to the RECIST 1:1 scale, before and during treatment. Results and discussion. Before therapy, according to RECIST 1.1 criteria, the target lesion selected was a formation on the posterior wall of the bladder, growing through the muscular layer of the wall, infiltrating the paravesical tissue, the orifice of the left ureter, with a maximum diameter of 3.0 cm; layer thickness of 0.9 cm, non-target lesion: hyperplasia of the iliac lymph node on the right up to 1.3 cm (MTS), urethrohydronephrosis on the left is noted (the ureter is dilated to 1.6 cm), SLD-3.0 cm. After 3 courses of chemotherapy, the size of the target formation decreased to 2.0 cm, layer thickness of 0.5 cm, non-target: regression of the MTS lesion, urethrohydronephrosis on the left persists (the ureter is dilated to 1.3 cm), nephrostomy, SLD-2.0 cm, a partial response to therapy is noted. Taking into account the partial effect of the chemotherapy treatment, the patient was given the monoclonal antibody Bavencio, where after 6 courses, a complete regression of the target formation and non-target lesions, elimination of nephrostomas was noted. Currently, the patient is on maintenance therapy with Bavencio, and the achieved complete regression of the process has been maintained for 21 months. Conclusion. According to clinical trial data, the use of Bavencio before progression or intolerable toxicity in the treatment of patients with RUC increases the median progression-free survival (3.7 months) and the median overall survival (21.4 months), and is a new standard of therapy.

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