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Conversion therapy with pembrolizumab for a peritoneal metastasis of rectal cancer causing hydronephrosis in a patient with Lynch syndrome

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Abstract

A 44-year-old woman with Lynch syndrome was referred to our hospital for treatment of recurrence of microsatellite instability-high rectal cancer. [18F]Fluorodeoxyglucose (18FDG)-positron emission tomography revealed a peritoneal metastasis with invasion to the small intestine and left ureter. The peritoneal metastasis was diagnosed initially as unresectable because of extensive invasion to the left ureter requiring nephrectomy. Hence, first-line treatment with pembrolizumab was started. After the first course of pembrolizumab, she developed hydronephrosis and a resulting urinary tract infection (UTI). A percutaneous nephrostomy was performed to control the UTI. After six courses of pembrolizumab, 18FDG-positron emission tomography showed that the peritoneal metastasis was smaller with significantly reduced 18FDG uptake, and it was then diagnosed as resectable without nephrectomy. She underwent R0 resection of the peritoneal metastasis with partial resection of the small intestine. Intraoperatively, the peritoneal metastasis showed no invasion of the left ureter, allowing its preservation. The percutaneous nephrostomy was removed postoperatively, and she has not developed any subsequent UTIs. Histopathologically, the tumor showed a pathological complete response to pembrolizumab. To the best of our knowledge, this is the first case of conversion therapy with pembrolizumab for peritoneal metastasis with hydronephrosis.

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Abbreviations

CRC :

Colorectal cancer

dMMR :

Mismatch repair-deficient

18FDG-PET :

[18F]fluorodeoxyglucose-positron emission tomography

ICI :

Immune checkpoint inhibitor

PD-1 :

Programmed cell death 1

UTI :

Urinary tract infection

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Authors and Affiliations

  1. Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata, 9518510, Japan

    Akio Matsumoto, Yoshifumi Shimada, Mae Nakano, Hikaru Ozeki, Daisuke Yamai & Toshifumi Wakai

  2. Medical Genome Center, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-Dori, Chuo-Ku, Niigata, Japan

    Yoshifumi Shimada, Mae Nakano, Masaki Murata, Fumio Ishizaki & Toshifumi Wakai

  3. Division of Urology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata, Japan

    Masaki Murata & Fumio Ishizaki

  4. Center for Medical Genetics, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-Dori, Chuo-Ku, Niigata, Japan

    Hiromi Nyuzuki & Takeshi Ikeuchi

Authors
  1. Akio Matsumoto
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  2. Yoshifumi Shimada
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Contributions

All authors made substantial contribution to the preparation of this manuscript and approved the final version for submission. AM and YS: drafted the manuscript; YS: corresponding author; MN, HO, DY, MM, FI, HN, and TI: clinical support; TW: careful review and final approval of the manuscript.

Corresponding author

Correspondence to Yoshifumi Shimada.

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Conflict of interest

The authors declare that they have no current financial arrangement or affiliation with any organization which may have a direct influence on their work.

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The study was reviewed and approved by the Institutional Review Board of Niigata University (G2015-0816, G2020-0038).

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Written informed consent was obtained from the patient for publication of this case report and accompanying images.

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Matsumoto, A., Shimada, Y., Nakano, M. et al. Conversion therapy with pembrolizumab for a peritoneal metastasis of rectal cancer causing hydronephrosis in a patient with Lynch syndrome. Clin J Gastroenterol (2024). https://doi.org/10.1007/s12328-024-01931-0

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