title: Metabolic complete response with vinflunine as second-line therapy in a kidney-transplanted patient with advanced urothelial carcinoma: a case report.
abstract: Patients undergone kidney transplantation present higher risk of Urothelial Carcinoma (UC) development and represent a subgroup of special interest. To date, vinflunine is the only drug approved in Europe for the treatment of advanced UC after failure of platinum-based chemotherapy. However, to our knowledge, no data on the concomitant administration of vinflunine and immunosuppressive agents are available.
  
  
  
  The patient, a 45 years old Caucasian male, presented poorly differentiated UC of the bladder recurred after initial cystectomy with abdominal lymphadenopathies evidenced by FDG-PET/CT. Previously, at the age of 22, he had post-glomerulonephritis renal failure and underwent kidney transplantation from deceased donor. Since then, he has been in treatment with immunosuppressive therapy. At the time of UC recurrence, he was on treatment with cyclosporine. After progression to platinum-based chemotherapy, he received second-line therapy with vinflunine resulting in a complete metabolic response after two cycles. However, despite several dose reductions, the patient experienced severe hematologic toxicity. The pharmacological interaction between vinflunine and cyclosporine, both metabolized by CYP 3A4, may explain the excellent result and the concomitant severe toxicity.
  
  
  
  Vinflunine is active on UC developed in kidney transplanted patients. However, special attention should be paid to concomitant administration with immunosuppressive agents that could result in increased toxicity.
authors: Medical Oncology Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy.
authors: Paola
authors: P
authors: Bordi
authors: Medical Oncology Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy.
authors: Marcello
authors: M
authors: Tiseo
authors: Nuclear Medicine Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy.
authors: Giorgio
authors: G
authors: Baldari
authors: Medical Oncology Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy. sebabuti@libero.it.
authors: Sebastiano
authors: S
authors: Buti
mesh_terms: D004347:Drug Interactions; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology; D019459:Urothelium / Q000473:pathology*; D014747:Vinblastine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D007166:Immunosuppressive Agents; C111217:vinflunine; D014747:Vinblastine
keywords: Immunosuppressive therapy; Kidney transplantation; Pharmacological interaction; Urothelial cancer; Vinflunine