Maintenance avelumab therapy for urothelial carcinoma in a hemodialysis patient: a case report

In recent years, immune checkpoint inhibitors have attracted attention in treatment for urothelial carcinoma. However, many clinical trials included only patients who had adequate renal function. The efficacy of immune checkpoint inhibitors for hemodialysis patients had not been well-documented. Herein, we report a case of a 73-years-old male with metastatic urothelial carcinoma. He was on maintenance hemodialysis, because he underwent total urinary tract resection for treatment of the urothelial carcinoma in his sixties. He was introduced to our hospital with metastases of lung and pubic bone, and was treated with chemotherapy including gemcitabine and paclitaxel. After two cycles, although his metastases decreased in size, he experienced severe anemia, diarrhea, and duodenitis. Therefore, he transitioned to maintenance therapy with avelumab earlier than initially planned. The treatment achieved 10 months disease control, without significant adverse events. To our best knowledge, this is the first case in which avelumab maintenance therapy achieved disease control of metastatic urothelial carcinoma in a hemodialysis patient.