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Modulation of PD-L1 Expression by Cisplatin and Gemcitabine in Bladder Cancer Cells

Yıl 2025, Cilt: 21 Sayı: 3, 28 - 34, 26.09.2025
https://doi.org/10.18466/cbayarfbe.1593948

Öz

Bladder cancer (BC) incidence is rising globally, despite available treatment options, including tumor resection, systemic chemotherapy, and immune checkpoint inhibitors targeting PD-1/PD-L1. Gemcitabine and cisplatin are commonly combined as first-line systemic therapy, yet their effects on PD-L1 expression remain unclear. This study evaluated the effects of cisplatin and gemcitabine, alone and combined, on PD-L1 expression in a BC cell line, RT-4, and a normal epithelial cell line, ARPE-19. Cells were treated with IC20 doses of each drug, and PD-L1 expression was quantified by qRT-PCR after 48 hours. In ARPE-19 cells, cisplatin treatment induced a dose-dependent PD-L1 increase, peaking at a 59.6-fold elevation at higher doses (p < 0.001), while gemcitabine alone showed no effect. The combination of low-dose cisplatin and gemcitabine further elevated PD-L1 expression (25.2-fold, p < 0.05). In contrast, in RT-4 cells, low-dose cisplatin downregulated PD-L1, but higher doses resulted in a 61.3-fold increase (p < 0.05). Gemcitabine alone downregulated PD-L1 in RT-4 cells; however, the combined treatment produced a 99.4-fold upregulation (p < 0.001). These findings highlight dose- and cell type-specific effects of cisplatin and gemcitabine on PD-L1 regulation, with combination therapy notably upregulating PD-L1 in BC cells. This underscores the potential for integrating chemotherapy with immune checkpoint inhibitors to counteract chemotherapy-induced immune evasion in BC. Differential responses between normal and cancer cells emphasize the need for tumor-specific therapeutic approaches and further research on PD-L1 regulation to optimize immune checkpoint therapy.

Kaynakça

  • [1.] Bray F, Ferlay J, et al. 2018. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians; 68: 394-424.
  • [2.] Martínez-Lacaci I, García Morales P, et al. 2007. Tumour cells resistance in cancer therapy. Clinical Translational Oncology; 9: 13-20.
  • [3.] Kaufman DS, Shipley WU, et al. 2009. Bladder cancer. The Lancet; 374: 239-249.
  • [4.] Sternberg CN, Bellmunt J, et al. 2013. ICUD-EAU international consultation on bladder cancer 2012: chemotherapy for urothelial carcinoma—neoadjuvant and adjuvant settings. European Urology; 63: 58-66.
  • [5.] Patel SP, Kurzrock R. 2015. PD-L1 expression as a predictive biomarker in cancer immunotherapy. Molecular Cancer Therapeutics; 14: 847-856.
  • [6.] Doroshow DB, Bhalla S, et al. 2021. PD-L1 as a biomarker of response to immune-checkpoint inhibitors. Nature Reviews Clinical Oncology; 18: 345-362.
  • [7.] Herbst RS, Soria JC, et al. 2014. Predictive correlates of response to the anti-PD-L1 antibody MPDL3280A in cancer patients. Nature; 515: 563-567.
  • [8.] Galsky MD, Daneshmand S, et al. 2023. Gemcitabine and cisplatin plus nivolumab as organ-sparing treatment for muscle-invasive bladder cancer: a phase 2 trial. Nature Medicine; 29: 2825-2834.
  • [9.] Kelley RK, Ueno M, et al. 2023. Pembrolizumab in combination with gemcitabine and cisplatin compared with gemcitabine and cisplatin alone for patients with advanced biliary tract cancer (KEYNOTE-966): a randomised, double-blind, placebo-controlled, phase 3 trial. The Lancet; 401: 1853-1865.
  • [10.] Sevim Nalkiran H, Akcora Yildiz D, et al. 2023. Targeting the anaphase-promoting complex/cyclosome (APC/C) enhanced antiproliferative and apoptotic response in bladder cancer. Saudi Journal of Biological Sciences; 30: 103564.
  • [11.] Durur S, Uzun H, et al. 2023. Prognostic importance of PD-L1 expression in bladder cancer patients. Journal of Cancer Research and Therapeutics; 19: S633-S638.
  • [12.] Chen M, Wang S. 2024. Preclinical development and clinical studies of targeted JAK/STAT combined Anti-PD-1/PD-L1 therapy. International Immunopharmacology; 130: 111717.
  • [13.] Antonangeli F, Natalini A, et al. 2020. Regulation of PD-L1 Expression by NF-κB in Cancer. Frontiers in Immunology; 11: 584626.
  • [14.] Kakoti S, Sato H, et al. 2020. DNA Repair and Signaling in Immune-Related Cancer Therapy. Frontiers in Molecular Biosciences; 7.
  • [15.] Babjuk M, Böhle A, et al. 2017. EAU guidelines on non–muscle-invasive urothelial carcinoma of the bladder: update 2016. European Urology; 71: 447-461.
  • [16.] Bellmunt J, De Wit R, et al. 2017. Pembrolizumab as second-line therapy for advanced urothelial carcinoma. New England Journal of Medicine; 376: 1015-1026.
  • [17.] Powles T, Park SH, et al. 2020. Avelumab maintenance therapy for advanced or metastatic urothelial carcinoma. New England Journal of Medicine; 383: 1218-1230.
  • [18.] Yoshino H, Yokoyama S, et al. 2023. Characterization and treatment of gemcitabine- and cisplatin-resistant bladder cancer cells with a pan-RAS inhibitor. FEBS Open Bio; 13: 1056-1066.
  • [19.] Aldossary S. 2019. Review on Pharmacology of Cisplatin: Clinical Use, Toxicity and Mechanism of Resistance of Cisplatin. Biomedical and Pharmacology Journal; 11: 07-15.
  • [20.] de Biasi AR, Villena-Vargas J, et al. 2014. Cisplatin-induced antitumor immunomodulation: a review of preclinical and clinical evidence. Clinical Cancer Research: An Official Journal of the American Association for Cancer; 20: 5384-5391.
  • [21.] Qin X, Liu C, et al. 2010. Cisplatin induces programmed death-1-ligand 1 (PD-L1) over-expression in hepatoma H22 cells via Erk/MAPK signaling pathway. Cellular Molecular Biology; 56: 1366-1372.
  • [22.] Zhang P, Su D-M, et al. 2008. Chemopreventive agents induce programmed death-1-ligand 1 (PD-L1) surface expression in breast cancer cells and promote PD-L1-mediated T cell apoptosis. Molecular Immunology; 45: 1470-1476.
  • [23.] Crinò L, Scagliotti G, et al. 1997. Cisplatin-gemcitabine combination in advanced non-small-cell lung cancer: a phase II study. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology; 15: 297-303.
  • [24.] von der Maase H, Sengelov L, et al. 2005. Long-term survival results of a randomized trial comparing gemcitabine plus cisplatin, with methotrexate, vinblastine, doxorubicin, plus cisplatin in patients with bladder cancer. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology; 23: 4602-4608.
  • [25.] Hitt R, Castellano D, et al. 1998. Phase II trial of cisplatin and gemcitabine in advanced squamous-cell carcinoma of the head and neck. Annals of Oncology: Official Journal of the European Society for Medical Oncology; 9: 1347-1349.
  • [26.] Nagourney RA, Flam M, et al. 2008. Carboplatin plus Gemcitabine Repeating Doublet Therapy in Recurrent Breast Cancer. Clinical Breast Cancer; 8: 432-435.
  • [27.] Pfisterer J, Plante M, et al. 2006. Gemcitabine plus carboplatin compared with carboplatin in patients with platinum-sensitive recurrent ovarian cancer: an intergroup trial of the AGO-OVAR, the NCIC CTG, and the EORTC GCG. Journal of Clinical Oncology; 24: 4699-4707.
  • [28.] Reck M, von Pawel J, et al. 2009. Phase III trial of cisplatin plus gemcitabine with either placebo or bevacizumab as first-line therapy for nonsquamous non–small-cell lung cancer: AVAiL. Journal of Clinical Oncology; 27: 1227-1234.
  • [29.] Emens LA, Middleton G. 2015. The interplay of immunotherapy and chemotherapy: harnessing potential synergies. Cancer immunology research; 3: 436-443.
  • [30.] Hanna GG, Coyle VM, et al. 2015. Immune modulation in advanced radiotherapies: targeting out-of-field effects. Cancer Letters; 368: 246-251.
  • [31.] Dong H, Strome SE, et al. 2002. Tumor-associated B7-H1 promotes T-cell apoptosis: a potential mechanism of immune evasion. Nature Medicine; 8: 793-800.
  • [32.] Iwai Y, Ishida M, et al. 2002. Involvement of PD-L1 on tumor cells in the escape from host immune system and tumor immunotherapy by PD-L1 blockade. Proceedings of the National Academy of Sciences; 99: 12293-12297.
  • [33.] Thompson RH, Kuntz SM, et al. 2006. Tumor B7-H1 is associated with poor prognosis in renal cell carcinoma patients with long-term follow-up. Cancer Research; 66: 3381-3385.
  • [34.] Wu C, Zhu Y, et al. 2006. Immunohistochemical localization of programmed death-1 ligand-1 (PD-L1) in gastric carcinoma and its clinical significance. Acta Histochemica; 108: 19-24.
  • [35.] Ghebeh H, Mohammed S, et al. 2006. The B7-H1 (PD-L1) T lymphocyte-inhibitory molecule is expressed in breast cancer patients with infiltrating ductal carcinoma: correlation with important high-risk prognostic factors. Neoplasia; 8: 190-198.
  • [36.] Fu D, Wu J, et al. 2020. T cell recruitment triggered by optimal dose platinum compounds contributes to the therapeutic efficacy of sequential PD-1 blockade in a mouse model of colon cancer. American Journal of Cancer Research; 10: 473.
  • [37.] Hu J, Kinn J, et al. 2013. The effects of chemotherapeutic drugs on human monocyte-derived dendritic cell differentiation and antigen presentation. Clinical Experimental Immunology; 172: 490-499.
  • [38.] Tran L, Allen CT, et al. 2017. Cisplatin alters antitumor immunity and synergizes with PD-1/PD-L1 inhibition in head and neck squamous cell carcinoma. Cancer Immunology Research; 5: 1141-1151.
  • [39.] Sawasdee N, Thepmalee C, et al. 2020. Gemcitabine enhances cytotoxic activity of effector T-lymphocytes against chemo-resistant cholangiocarcinoma cells. International Immunopharmacology; 78: 106006.
  • [40.] Oing C, Rink M, et al. 2016. Second line chemotherapy for advanced and metastatic urothelial carcinoma: vinflunine and beyond—a comprehensive review of the current literature. The Journal of Urology; 195: 254-263.

Modulation of PD-L1 Expression by Cisplatin and Gemcitabine in Bladder Cancer Cells

Yıl 2025, Cilt: 21 Sayı: 3, 28 - 34, 26.09.2025
https://doi.org/10.18466/cbayarfbe.1593948

Öz

Bladder cancer (BC) incidence is rising globally, despite available treatment options, including tumor resection, systemic chemotherapy, and immune checkpoint inhibitors targeting PD-1/PD-L1. Gemcitabine and cisplatin are commonly combined as first-line systemic therapy, yet their effects on PD-L1 expression remain unclear. This study evaluated the effects of cisplatin and gemcitabine, alone and combined, on PD-L1 expression in a BC cell line, RT-4 and normal epithelial cell line, ARPE-19. Cells were treated with IC20 doses of each drug, and PD-L1 expression was quantified by qRT-PCR after 48 hours. In ARPE-19 cells, cisplatin treatment induced a dose-dependent PD-L1 increase, peaking at a 59.6-fold elevation at higher doses (p < 0.001), while gemcitabine alone showed no effect. The combination of low-dose cisplatin and gemcitabine further elevated PD-L1 expression (25.2-fold, p < 0.05). In contrast, in RT-4 cells, low-dose cisplatin downregulated PD-L1, but higher doses resulted in a 61.3-fold increase (p < 0.05). Gemcitabine alone downregulated PD-L1 in RT-4 cells; however, the combined treatment produced a 99.4-fold upregulation (p < 0.001). These findings highlight dose- and cell type-specific effects of cisplatin and gemcitabine on PD-L1 regulation, with combination therapy notably upregulating PD-L1 in BC cells. This underscores the potential for integrating chemotherapy with immune checkpoint inhibitors to counteract chemotherapy-induced immune evasion in BC. Differential responses between normal and cancer cells emphasize the need for tumor-specific therapeutic approaches and further research on PD-L1 regulation to optimize immune checkpoint therapy.

Kaynakça

  • [1.] Bray F, Ferlay J, et al. 2018. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians; 68: 394-424.
  • [2.] Martínez-Lacaci I, García Morales P, et al. 2007. Tumour cells resistance in cancer therapy. Clinical Translational Oncology; 9: 13-20.
  • [3.] Kaufman DS, Shipley WU, et al. 2009. Bladder cancer. The Lancet; 374: 239-249.
  • [4.] Sternberg CN, Bellmunt J, et al. 2013. ICUD-EAU international consultation on bladder cancer 2012: chemotherapy for urothelial carcinoma—neoadjuvant and adjuvant settings. European Urology; 63: 58-66.
  • [5.] Patel SP, Kurzrock R. 2015. PD-L1 expression as a predictive biomarker in cancer immunotherapy. Molecular Cancer Therapeutics; 14: 847-856.
  • [6.] Doroshow DB, Bhalla S, et al. 2021. PD-L1 as a biomarker of response to immune-checkpoint inhibitors. Nature Reviews Clinical Oncology; 18: 345-362.
  • [7.] Herbst RS, Soria JC, et al. 2014. Predictive correlates of response to the anti-PD-L1 antibody MPDL3280A in cancer patients. Nature; 515: 563-567.
  • [8.] Galsky MD, Daneshmand S, et al. 2023. Gemcitabine and cisplatin plus nivolumab as organ-sparing treatment for muscle-invasive bladder cancer: a phase 2 trial. Nature Medicine; 29: 2825-2834.
  • [9.] Kelley RK, Ueno M, et al. 2023. Pembrolizumab in combination with gemcitabine and cisplatin compared with gemcitabine and cisplatin alone for patients with advanced biliary tract cancer (KEYNOTE-966): a randomised, double-blind, placebo-controlled, phase 3 trial. The Lancet; 401: 1853-1865.
  • [10.] Sevim Nalkiran H, Akcora Yildiz D, et al. 2023. Targeting the anaphase-promoting complex/cyclosome (APC/C) enhanced antiproliferative and apoptotic response in bladder cancer. Saudi Journal of Biological Sciences; 30: 103564.
  • [11.] Durur S, Uzun H, et al. 2023. Prognostic importance of PD-L1 expression in bladder cancer patients. Journal of Cancer Research and Therapeutics; 19: S633-S638.
  • [12.] Chen M, Wang S. 2024. Preclinical development and clinical studies of targeted JAK/STAT combined Anti-PD-1/PD-L1 therapy. International Immunopharmacology; 130: 111717.
  • [13.] Antonangeli F, Natalini A, et al. 2020. Regulation of PD-L1 Expression by NF-κB in Cancer. Frontiers in Immunology; 11: 584626.
  • [14.] Kakoti S, Sato H, et al. 2020. DNA Repair and Signaling in Immune-Related Cancer Therapy. Frontiers in Molecular Biosciences; 7.
  • [15.] Babjuk M, Böhle A, et al. 2017. EAU guidelines on non–muscle-invasive urothelial carcinoma of the bladder: update 2016. European Urology; 71: 447-461.
  • [16.] Bellmunt J, De Wit R, et al. 2017. Pembrolizumab as second-line therapy for advanced urothelial carcinoma. New England Journal of Medicine; 376: 1015-1026.
  • [17.] Powles T, Park SH, et al. 2020. Avelumab maintenance therapy for advanced or metastatic urothelial carcinoma. New England Journal of Medicine; 383: 1218-1230.
  • [18.] Yoshino H, Yokoyama S, et al. 2023. Characterization and treatment of gemcitabine- and cisplatin-resistant bladder cancer cells with a pan-RAS inhibitor. FEBS Open Bio; 13: 1056-1066.
  • [19.] Aldossary S. 2019. Review on Pharmacology of Cisplatin: Clinical Use, Toxicity and Mechanism of Resistance of Cisplatin. Biomedical and Pharmacology Journal; 11: 07-15.
  • [20.] de Biasi AR, Villena-Vargas J, et al. 2014. Cisplatin-induced antitumor immunomodulation: a review of preclinical and clinical evidence. Clinical Cancer Research: An Official Journal of the American Association for Cancer; 20: 5384-5391.
  • [21.] Qin X, Liu C, et al. 2010. Cisplatin induces programmed death-1-ligand 1 (PD-L1) over-expression in hepatoma H22 cells via Erk/MAPK signaling pathway. Cellular Molecular Biology; 56: 1366-1372.
  • [22.] Zhang P, Su D-M, et al. 2008. Chemopreventive agents induce programmed death-1-ligand 1 (PD-L1) surface expression in breast cancer cells and promote PD-L1-mediated T cell apoptosis. Molecular Immunology; 45: 1470-1476.
  • [23.] Crinò L, Scagliotti G, et al. 1997. Cisplatin-gemcitabine combination in advanced non-small-cell lung cancer: a phase II study. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology; 15: 297-303.
  • [24.] von der Maase H, Sengelov L, et al. 2005. Long-term survival results of a randomized trial comparing gemcitabine plus cisplatin, with methotrexate, vinblastine, doxorubicin, plus cisplatin in patients with bladder cancer. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology; 23: 4602-4608.
  • [25.] Hitt R, Castellano D, et al. 1998. Phase II trial of cisplatin and gemcitabine in advanced squamous-cell carcinoma of the head and neck. Annals of Oncology: Official Journal of the European Society for Medical Oncology; 9: 1347-1349.
  • [26.] Nagourney RA, Flam M, et al. 2008. Carboplatin plus Gemcitabine Repeating Doublet Therapy in Recurrent Breast Cancer. Clinical Breast Cancer; 8: 432-435.
  • [27.] Pfisterer J, Plante M, et al. 2006. Gemcitabine plus carboplatin compared with carboplatin in patients with platinum-sensitive recurrent ovarian cancer: an intergroup trial of the AGO-OVAR, the NCIC CTG, and the EORTC GCG. Journal of Clinical Oncology; 24: 4699-4707.
  • [28.] Reck M, von Pawel J, et al. 2009. Phase III trial of cisplatin plus gemcitabine with either placebo or bevacizumab as first-line therapy for nonsquamous non–small-cell lung cancer: AVAiL. Journal of Clinical Oncology; 27: 1227-1234.
  • [29.] Emens LA, Middleton G. 2015. The interplay of immunotherapy and chemotherapy: harnessing potential synergies. Cancer immunology research; 3: 436-443.
  • [30.] Hanna GG, Coyle VM, et al. 2015. Immune modulation in advanced radiotherapies: targeting out-of-field effects. Cancer Letters; 368: 246-251.
  • [31.] Dong H, Strome SE, et al. 2002. Tumor-associated B7-H1 promotes T-cell apoptosis: a potential mechanism of immune evasion. Nature Medicine; 8: 793-800.
  • [32.] Iwai Y, Ishida M, et al. 2002. Involvement of PD-L1 on tumor cells in the escape from host immune system and tumor immunotherapy by PD-L1 blockade. Proceedings of the National Academy of Sciences; 99: 12293-12297.
  • [33.] Thompson RH, Kuntz SM, et al. 2006. Tumor B7-H1 is associated with poor prognosis in renal cell carcinoma patients with long-term follow-up. Cancer Research; 66: 3381-3385.
  • [34.] Wu C, Zhu Y, et al. 2006. Immunohistochemical localization of programmed death-1 ligand-1 (PD-L1) in gastric carcinoma and its clinical significance. Acta Histochemica; 108: 19-24.
  • [35.] Ghebeh H, Mohammed S, et al. 2006. The B7-H1 (PD-L1) T lymphocyte-inhibitory molecule is expressed in breast cancer patients with infiltrating ductal carcinoma: correlation with important high-risk prognostic factors. Neoplasia; 8: 190-198.
  • [36.] Fu D, Wu J, et al. 2020. T cell recruitment triggered by optimal dose platinum compounds contributes to the therapeutic efficacy of sequential PD-1 blockade in a mouse model of colon cancer. American Journal of Cancer Research; 10: 473.
  • [37.] Hu J, Kinn J, et al. 2013. The effects of chemotherapeutic drugs on human monocyte-derived dendritic cell differentiation and antigen presentation. Clinical Experimental Immunology; 172: 490-499.
  • [38.] Tran L, Allen CT, et al. 2017. Cisplatin alters antitumor immunity and synergizes with PD-1/PD-L1 inhibition in head and neck squamous cell carcinoma. Cancer Immunology Research; 5: 1141-1151.
  • [39.] Sawasdee N, Thepmalee C, et al. 2020. Gemcitabine enhances cytotoxic activity of effector T-lymphocytes against chemo-resistant cholangiocarcinoma cells. International Immunopharmacology; 78: 106006.
  • [40.] Oing C, Rink M, et al. 2016. Second line chemotherapy for advanced and metastatic urothelial carcinoma: vinflunine and beyond—a comprehensive review of the current literature. The Journal of Urology; 195: 254-263.
Toplam 40 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Nanokimya
Bölüm Makaleler
Yazarlar

İhsan Nalkıran 0000-0002-7246-2592

Hatice Sevim Nalkıran 0000-0002-1115-2005

Yayımlanma Tarihi 26 Eylül 2025
Gönderilme Tarihi 1 Aralık 2024
Kabul Tarihi 19 Haziran 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 21 Sayı: 3

Kaynak Göster

APA Nalkıran, İ., & Sevim Nalkıran, H. (2025). Modulation of PD-L1 Expression by Cisplatin and Gemcitabine in Bladder Cancer Cells. Celal Bayar University Journal of Science, 21(3), 28-34. https://doi.org/10.18466/cbayarfbe.1593948
AMA Nalkıran İ, Sevim Nalkıran H. Modulation of PD-L1 Expression by Cisplatin and Gemcitabine in Bladder Cancer Cells. Celal Bayar University Journal of Science. Eylül 2025;21(3):28-34. doi:10.18466/cbayarfbe.1593948
Chicago Nalkıran, İhsan, ve Hatice Sevim Nalkıran. “Modulation of PD-L1 Expression by Cisplatin and Gemcitabine in Bladder Cancer Cells”. Celal Bayar University Journal of Science 21, sy. 3 (Eylül 2025): 28-34. https://doi.org/10.18466/cbayarfbe.1593948.
EndNote Nalkıran İ, Sevim Nalkıran H (01 Eylül 2025) Modulation of PD-L1 Expression by Cisplatin and Gemcitabine in Bladder Cancer Cells. Celal Bayar University Journal of Science 21 3 28–34.
IEEE İ. Nalkıran ve H. Sevim Nalkıran, “Modulation of PD-L1 Expression by Cisplatin and Gemcitabine in Bladder Cancer Cells”, Celal Bayar University Journal of Science, c. 21, sy. 3, ss. 28–34, 2025, doi: 10.18466/cbayarfbe.1593948.
ISNAD Nalkıran, İhsan - Sevim Nalkıran, Hatice. “Modulation of PD-L1 Expression by Cisplatin and Gemcitabine in Bladder Cancer Cells”. Celal Bayar University Journal of Science 21/3 (Eylül2025), 28-34. https://doi.org/10.18466/cbayarfbe.1593948.
JAMA Nalkıran İ, Sevim Nalkıran H. Modulation of PD-L1 Expression by Cisplatin and Gemcitabine in Bladder Cancer Cells. Celal Bayar University Journal of Science. 2025;21:28–34.
MLA Nalkıran, İhsan ve Hatice Sevim Nalkıran. “Modulation of PD-L1 Expression by Cisplatin and Gemcitabine in Bladder Cancer Cells”. Celal Bayar University Journal of Science, c. 21, sy. 3, 2025, ss. 28-34, doi:10.18466/cbayarfbe.1593948.
Vancouver Nalkıran İ, Sevim Nalkıran H. Modulation of PD-L1 Expression by Cisplatin and Gemcitabine in Bladder Cancer Cells. Celal Bayar University Journal of Science. 2025;21(3):28-34.