Page 62 - ARNM-1-1

Advances in Radiotherapy
& Nuclear Medicine PRaG therapy for renal pelvis carcinoma

describe a case study of a patient with advanced refractory unirradiated regions (Figure 1). After the occurrence of
primary cancer who had previously exhibited resistance to reactive cutaneous capillary endothelial proliferation due
therapy with PD-1 inhibitors. However, during follow-up to camrelizumab treatment, sintilimab was administered
treatment, the patient exhibited a favorable clinical response during the 3 -4 maintenance therapy cycles. A PET-CT
th
rd
to a quadruple-combination therapy comprising radiation scan carried out on December 7 , 2021, demonstrated the
th
therapy in conjunction with the sequential administration expansion of lymph nodes adjacent to the right inferior
of PD-1 inhibitors, granulocyte-macrophage colony- vena cava (Figure 1), warranting a reassessment of the
stimulating factor (GM-CSF), and interleukin-2 (IL-2). patient’s treatment response, which was observed to be
To the best of our knowledge, the case represents the first PD. The PFS2 was noted to be 5 months. The patient’s
instance, in which RPC has been reported within this treatment regimen was modified by resuming the PRaG
specific context. 2.0 therapy for two more cycles and subjecting the lymph

2. Case presentation nodes contiguous to the inferior vena cava to radiotherapy,
as shown in Figure S4, on December 9 , 2021. Following
th
In 2021, a 58-year-old female was diagnosed with RPC the completion of PRaG 2.0 therapy, the patient underwent
accompanied by multiple lymph node metastases in the two additional cycles of maintenance therapy with a PD-1
right retroperitoneum (Figure S1). The patient underwent inhibitor (sintilimab). A PET-CT scan conducted on
a right nephroureterectomy at the Department of Urology February 8 , 2022, demonstrated a decrease in the number
th
in the Second Affiliated Hospital of Soochow University on of lesions and a reduction in the FDG metabolism at
January 4 , 2021, as a consequence of advanced stage RPC the unirradiated regions, as represented in Figure 1. The
th
classified as pT4N2M0, Stage IV. Immunohistochemical aforementioned observations were interpreted to imply
analysis of the tumor tissue demonstrated a lack of PD-L1 amelioration in the patient’s condition, leading to the
expression and a Ki-67 expression level of 70% (Figure S2). assessment of the treatment as a PR.
From February 2021 until June 2021, the patient was
administered a total of six cycles of cisplatin and gemcitabine During the follow-up period, the patient demonstrated
chemotherapy in combination with tislelizumab at the recurrent resistance to the PD-1 inhibitor, which was
th
Urology Department of the Second Affiliated Hospital of noted on May 9 , 2022, resulting in a PFS3 of 5 months.
Soochow University. Unfortunately, on May 13 , 2021, a Subsequent to that, the patient was enrolled in PraG 3.0
th
positron emission tomography-computed tomography (NCT05115500), which combines the administration of
(PET-CT) scan indicated progressive disease (PD), ADC, PD-1 inhibitor, and radiotherapy, accompanied
revealing multiple nodules in the vicinity of the right by the sequential use of GM-CSF and IL-2, established
kidney following the operation and at its surroundings particularly for patients with HER2-expressing advanced
(L5-S3 level), with elevated levels of fluorodeoxyglucose solid tumors. At the time of this case report, the patient
(FDG) metabolism (Figure 1). Following the primary had a good performance status. The timeline of the entire
treatment, the patient achieved a progression-free treatment process for the patient is shown in Figure 3.
survival of 4 months (PFS1). Consequently, on July 6 ,
th
2021, the patient was enrolled in the PRaG 2.0 clinical 3. Discussion
trial (NCT04892498). The prescribed treatment regimen In this case, the patient, diagnosed with RPC, manifested
comprised subcutaneous administration of GM-CSF disease progression despite undergoing adjuvant therapy
(200 µg once daily, day 1 – 7) and IL-2 (200 million UI with a PD-1 inhibitor, exhibiting a PFS of merely
once daily, day 8–14) in conjunction with radiotherapy 4 months. Gratifyingly, the patient exemplified a PR and
(5 Gy/d, day 1–2), followed by the administration of a a PFS2 duration of 5 months subsequent to the initial
PD-1 inhibitor (camrelizumab 200 mg, day 3). two cycles of PRaG 2.0 therapy. Furthermore, the patient
The PRaG 2.0 therapy was administered every 3 weeks evinced a PFS3 duration of 5 months following the
st
for two cycles (Figure S3). On August 31 , 2021, the subsequent two cycles of PRaG 2.0 therapy. Apart from
patient was assessed for the treatment response through this, the patient’s physical state and standard of living
CT utilizing the Response Evaluation Criteria in Solid remained unaltered, despite PFS2 and PFS3 measuring
Tumor (RECIST v1.1), revealing a partial response <6 months. Our observations suggest improved survival
(PR) (Figure 2). Subsequent to the PRaG 2.0 therapy, prospects in this illness with unfavorable prognostic
the patient underwent PD-1 inhibitor (camrelizumab, characteristics with the implementation of PRaG 2.0
200 mg/q3w) monotherapy for two additional cycles. On therapy. It is noteworthy that treating relapsed urothelial
September 24 , 2021, a PET-CT scan demonstrated a carcinoma (UC) remains a daunting task in second-line
th
notable reduction in tumor mass at both irradiated and therapy.

Volume 1 Issue 1 (2023) 2 https://doi.org/10.36922/arnm.0441