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Medicina
Volume 57
Issue 9
10.3390/medicina57090987
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Case Report
Peer-Review Record

A Rare Case Report of Metastatic Urothelial Carcinoma to Skull with Significant Reossification after Pembrolizumab

Medicina 2021, 57(9), 987; https://doi.org/10.3390/medicina57090987
by Yung-Hao Liu, Meng-Han Chou, En Meng and Chien-Chang Kao *
Reviewer 1: Anonymous
Reviewer 2: Anonymous
Reviewer 3:
Alak Manna
Medicina 2021, 57(9), 987; https://doi.org/10.3390/medicina57090987
Submission received: 24 August 2021 / Revised: 14 September 2021 / Accepted: 17 September 2021 / Published: 18 September 2021
(This article belongs to the Section Oncology)

Round 1

Reviewer 1 Report

It is very interesting to see such dramatic response to a metastatic site after initiation of Pembrolizumab, however, the real clinical impact is unclear.

Author Response

Dear reviewer,

As non-native English speaker, in order to improve readability, we have enclosed a certificate of English correction.

Best regards,
Yung-Hao Liu

Author Response File: Author Response.pdf

Reviewer 2 Report

Authors reported a rare case of metastatic Urothelial Carcinoma to Skull with significant reossification after Pembrolizumab. Few questions need to be addressed 

  • Can authors show a biopsy from the patient with the expression of PDL-1 on tumor cells
  • During Immunotherapy did the patient present any systemic adverse effects and if yes please mention it in the manuscript.
  • Authors showed a PET and CT at two time point before treatment (Chemotherapy) and after treatment (Immunotherapy) however its lakes a PET and CT just before the treatment with Pembrolizumab was any performed before immunotherapy? To add it to the manuscript.
  • In the discussion authors argue the use of Immunotherapy as first line treatment in advanced stage based on there study and a previous study showing a remission after immunotherapy. However, in both case we cannot roll out the effect of chemotherapy because both patients were treated with chemotherapy before starting immunotherapy. Chemotherapy may have a role in killing cancer cells and release of tumor antigens that can activate T cells rendering Pembrolizumab more effective in the presence of activated T cells. Hence it may also interesting to discuss this point and study the possibility of combination therapy chemo + immunotherapy in patient with advanced stage.

 

Author Response

Dear reviewer,

Please see the attachment. Thank you very much for your time!

Best regards,
Yung-Hao Liu

Author Response File: Author Response.docx

Reviewer 3 Report

The author presented a really rare case in this case report entitled “A Rare Case Report of Metastatic Urothelial Carcinoma to Skull 2 with Significant Reossification after Pembrolizumab”.

This report is no doubt a unique case that Liu et al., pointed out. It is nicely written and concisely drafted.

I have few minor comments those will improve the quality of the manuscript.

Line 28: what NCCN stand for?

Line 61: Doses of Pembrolizumab will benefit the reader

Overall, comments, is the re-ossification due to long-term chemo followed by immunotherapy? Or it is the side effect of immunotherapy?

 

Author Response

Dear reviewer,

Please see the attachment. Thank you very much for your time!

Best regards,
Yung-Hao Liu

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

Authors made the changes required for publication.

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