A Case of Advanced Urothelial Carcinoma Requiring Treatment Following a Positive Interferon-Gamma Release Assay Prior to Avelumab Administration

Q4 Medicine

IJU Case Reports Pub Date : 2025-06-24 DOI:10.1002/iju5.70063

Yukiya Odagiri, Yoshiki Hiyama, Umi Ishida, Naotaka Nishiyama, Yoshihiro Yamamoto, Hiroshi Kitamura

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Abstract

Introduction

The association between the risk of latent tuberculosis infection (LTBI) reactivation and immune checkpoint inhibitor (ICI) administration has been reported.

Case Presentation

A man in his seventies underwent robot-assisted laparoscopic radical cystectomy with ileal conduit diversion for muscle-invasive bladder cancer. Three years postoperatively, CT revealed metastases to the para-aortic lymph nodes and rectum. Four cycles of gemcitabine and carboplatin were administered, with CT showing a partial response (PR). Avelumab maintenance therapy was initiated following radiotherapy for the rectal metastasis. Prior to avelumab administration, LTBI was diagnosed based on a positive interferon-gamma release assay (IGRA). Isoniazid was administered concurrently with avelumab for 6 months. No active tuberculosis developed, and PR was maintained.

Conclusion

IGRA screening is advisable prior to ICI initiation. Prompt and appropriate management is warranted in patients with LTBI.

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1例晚期尿路上皮癌在使用Avelumab前干扰素- γ释放试验阳性后需要治疗

已经报道了潜伏性结核感染（LTBI）再激活风险与免疫检查点抑制剂（ICI）使用之间的关联。一例70多岁男性因肌肉浸润性膀胱癌行机器人辅助腹腔镜根治性膀胱切除术并回肠导管转移。术后3年，CT显示转移到主动脉旁淋巴结和直肠。给予吉西他滨和卡铂四个周期，CT显示部分缓解（PR）。直肠转移放疗后开始Avelumab维持治疗。在使用avelumab之前，LTBI是基于干扰素γ释放试验（IGRA）阳性诊断的。异烟肼与avelumab同时使用6个月。无活动性结核发生，PR维持。结论在ICI开始前进行IGRA筛查是可取的。对LTBI患者进行及时和适当的治疗是必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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