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CASE REPORT article

Front. Oncol.
Sec. Genitourinary Oncology
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1465213
This article is part of the Research Topic The Role of Immunotherapy in Urothelial Cancer View all 6 articles

Radical robotic nephroureterectomy after chemotherapy followed by avelumab in a patient with node-positive UTUC

Provisionally accepted
Hana Studentova Hana Studentova 1,2*Vladimir Student Vladimir Student 3,4Daniela Kurfurstova Daniela Kurfurstova 5,6Andrea Kopova Andrea Kopova 1,2Bohuslav Melichar Bohuslav Melichar 1,2
  • 1 Department of Oncology, University Hospital Olomouc, Olomouc, Czechia
  • 2 Department of Oncology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Olomouc, Czechia
  • 3 Department of Urology, University Hospital Olomouc, Olomouc, Olomouc, Czechia
  • 4 Department of Urology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czechia
  • 5 Department of Clinical and Molecular Pathology, University Hospital Olomouc, Olomouc, Olomouc, Czechia
  • 6 Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Olomouc, Czechia

The final, formatted version of the article will be published soon.

    Introduction: Platinum-based chemotherapy followed by the immune checkpoint inhibitor avelumab represents an intensified upfront therapy regimen that may result in significant downstaging and, subsequently, potentially radical robotic nephroureterectomy with a lymph node dissection, an uncommon approach with an unexpectedly favorable outcome. Case presentation: We report a case of a 70-year-old female presented with a sizeable cN2+ tumor of the left renal pelvis and achieved deep partial radiologic response after systemic therapy with four cycles of gemcitabine-cisplatin chemotherapy followed by avelumab maintenance therapy and subsequent robotic resection of the tumor. The patient continued with adjuvant nivolumab therapy once recovered after surgery and remained tumor-free on the subsequent follow-up. The systemic treatment was without any severe adverse reaction. Conclusion: We highlight the feasibility of the upfront systemic therapy with four cycles of gemcitabine-cisplatin chemotherapy followed by avelumab maintenance, robotic-assisted removal of the tumor, and adjuvant immunotherapy with nivolumab. This intensification of the upfront systemic therapy, and the actual treatment sequence significantly increase the chances of prolonged survival or even a cure. This type of personalized therapeutic approach can accelerate future advanced immunotherapeutic strategies.

    Keywords: Upper urinary tract carcinoma, UTUC, Neoadjuvant chemotherapy, Radical nephroureterectomy, Immunotherapy, immune checkpoint inhibitors, Cancer-specific survival

    Received: 15 Jul 2024; Accepted: 14 Oct 2024.

    Copyright: © 2024 Studentova, Student, Kurfurstova, Kopova and Melichar. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Hana Studentova, Department of Oncology, University Hospital Olomouc, Olomouc, Czechia

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.