Emerging biomarkers in metastatic urothelial carcinoma: tumour mutational burden, PD-L1 expression and APOBEC polypeptide-like signature in a patient with complete response to anti-programmed cell death protein-1 inhibitor

Immunotherapy has recently been incorporated into the treatment guidelines for metastatic urothelial carcinoma. Nevertheless, the role of prognostic and predictive biomarkers in this setting is not completely defined. To date, PD-L1 expression and a high tumour mutational burden (TMB) seem to predic...

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Published inEcancermedicalscience Vol. 15; p. 1306
Main Authors Queiroz, Marcello Moro, de Souza, Zenaide Silva, Gongora, Aline Bobato Lara, de Galiza Barbosa, Felipe, Buchpiguel, Carlos Alberto, de Castro, Marilia Germanos, de Macedo, Mariana Petaccia, Coelho, Rafael Ferreira, Sokol, Ethan Samuel, Camargo, Anamaria Aranha, Bastos, Diogo Assed
Format Journal Article
LanguageEnglish
Published England Cancer Intelligence 22.10.2021
Subjects
Apoptosis
Biomarkers
Bladder cancer
Cancer therapies
Case Report
Cell death
Chemotherapy
Cost analysis
FDA approval
Immunotherapy
Medical prognosis
Metastasis
Mortality
Patients
Polypeptides
United States > US
PD-L1
tumour mutational burden
metastatic
biomarkers
bladder cancer
immunotherapy
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Summary:Immunotherapy has recently been incorporated into the treatment guidelines for metastatic urothelial carcinoma. Nevertheless, the role of prognostic and predictive biomarkers in this setting is not completely defined. To date, PD-L1 expression and a high tumour mutational burden (TMB) seem to predict better responses to immune checkpoint inhibitors, but patients without these biomarkers may still respond to immunotherapy. There are some caveats regarding these biomarkers, such as lack of standardisation of techniques, tumour heterogeneity and other factors influencing the tumour microenvironment. Genomic signatures are other promising emerging strategies. We hereby discuss the management of a 70-year-old man with a metastatic recurrence of urothelial carcinoma within 1 year after neoadjuvant chemotherapy and radical cystectomy. Tumour next-generation sequencing showed a high TMB and a (PD-L1) amplification. The patient was treated with pembrolizumab and achieved a complete response.
ISSN:1754-6605
1754-6605
DOI:10.3332/ecancer.2021.1306