[ONE COURSE OF PEMBROLIZUMAB AFTER RADIATION THERAPY WAS VERY EFFECTIVE AGAINST METASTATIC BLADDER CANCER AND CR WAS CONFIRMED: A CASE REPORT].

A 78-year-old man was referred to our institution for the evaluation of macroscopic hematuria and a bladder tumor for which we initially performed a transurethral resection of the bladder tumor. Pathological examination revealed that the tumor was a high-grade invasive urothelial carcinoma that was at least stage T2. Computed tomography scan showed a bladder carcinoma with no nodal or distant metastases. Assuming radical cystectomy, we administered two courses of neoadjuvant chemotherapy (i.e., gemcitabine and cisplatin chemotherapy). Unfortunately, the bladder tumor metastasized to the right internal iliac lymph node. We performed consolidative radiotherapy (54 Gy/ 27 fractions to the bladder area containing the right internal iliac lymph node). One month later, bilateral lung metastases and local penile infiltration appeared; thus, second-line chemotherapy (pembrolizumab) was added to the regimen. The patient rejected further chemotherapy after the first course of pembrolizumab. A computed tomography scan performed four months after one course of pembrolizumab therapy showed complete resolution of the metastatic lesions. As of this writing, 20 months after the first course of pembrolizumab, the patient continues to be in complete remission.