Evaluation of predictive factors in patients with bladder cancer undergoing atezolizumab treatment: Case reports

This series consists of three cases. Clinical features and pathological characteristics, expression of tumor-infiltrating lymphocytes (TIL), TIL-PD-L1 expression, microsatellite instability (MSI), and programmed death-ligand (PD-L1) were evaluated for predicting response to immunotherapy in patients receiving atezolizumab for advanced bladder cancer. Tumor PDL-1 level was 80% in case 1; however, PDL-1 level was detected as 0% in other cases. TIL PDL-1 level was 5% in the first case, and 1% and 0% in the second and third cases, respectively. TIL density was higher in the first case than in the other two cases. MSI was not detected in any of the cases. With atezolizumab treatment, the radiologic response was obtained only in the first case and progression free survival (PFS) lasting 8 months was detected. In the other two cases, there was no response with atezolizumab and the disease progressed. When the clinical factors (performance status, hemoglobin level, presence of liver metastases, and response time to platinum regimen) predicting the response to the second series of treatments were evaluated, patients had a risk factor of 0, 2, and 3, respectively. The overall survival of the cases was determined as 28, 11, and 11 months, respectively. In our study, when compared with the other cases, the first case reported a higher PD-L1, higher TIL PD-L1 level, higher TIL density, and low clinical risk factors and had longer survival with atezolizumab.