Enfortumab vedotin as a salvage option as 5th line therapy for metastatic urothelial bladder cancer

Abstract

A 67-year-old female patient with a muscle-invasive, non-metastatic urothelial bladder cancer (UC) (pT2 G3 cN0 cM0) developed metachronous metastases within 6 months after radical cystectomy with ileal conduit urinary diversion.

After a good primary response to platinum-based chemotherapy, treatment was switched to the immune checkpoint inhibitor (ICI) pembrolizumab due to progressive disease. Subsequently the patient underwent selective internal radiotherapy (SIRT) of the liver and received vinflunine as well as a re-challenge with pembrolizumab.

Two years after the initial diagnosis, rapid disease progression ultimately led to a switch to 5th line therapy with enfortumab vedotin (EV), which had only been approved in the United States at that time. The antibody-drug conjugate was well tolerated by the patient after dose reduction to 1.0 mg/ kg body weight. Simultaneous irradiation of newly occurring precardiac, hepatic and cerebral metastases were necessary. After 10 months of therapy with EV, tumour regression was observed accompanied with good symptom control.

The presented case illustrates the efficacy and tolerability of EV in a heavily pre-treated patient with metastatic UC (mUC).

Zusammenfassung

Eine 67-jährige Patientin mit Urothelkarzinom (UC) der Harnblase entwickelte nach kurativer radikaler Zystektomie mit Ileumconduit-Anlage (pT2 N0 M0) einen Frühprogress mit metachroner Metastasierung. Nach primär gutem Ansprechen auf eine platinhaltige Chemotherapie erfolgte bei Progress eine Zweitlinientherapie mit dem Checkpointinhibitor Pembrolizumab. Bei erneut isoliert hepatischem Metastasennachweis kam nach selektiver interner Radiotherapie (SIRT), bei nochmaligem Progress Vinflunin und in rascher Folge wiederholt Pembrolizumab zum Einsatz. Knapp 2 Jahre nach Erstdiagnose erfolgte bei fortschreitender Tumorerkrankung ein Therapiewechsel auf das bis dato nur in den USA zugelassene Enfortumab Vedotin. Das Antikörper-Drug-Konjugat wurde von der Patientin in reduzierter Dosierung (1mg/ kg KG) gut vertragen. Zwischenzeitlich wurden simultan Bestrahlungen neu aufgetretener präkardialer, hepatischer sowie einer zerebralen Metastase notwendig. Nach 10-monatiger Therapielaufzeit war ein Tumorregress bei guter Symptomkontrolle zu verzeichnen.

Enfortumab Vedotin zeigte hier bei intensiv vorbehandelter Patientin eine gute Verträglichkeit sowie Wirkung beim M1 UC der Harnblase. Entsprechend unterstreicht der Fall, dass der Einsatz von Medikamenten, die zunächst nur im Ausland zugelassen sind, für entsprechend vorbehandelte Krebspatienten mit gutem Performance-Status, als individueller Heilversuch in Betracht gezogen werden sollte.

Keywords

urothelial bladder cancer - enfortumab vedotin - metachronic metastases - antibody-drug conjugate - immunotherapy

Schlüsselwörter

Urothelkarzinom - Enfortumab Vedotin - Antikörper-Drug-Konjugat - metachrone Metastasierung - Immuntherapie

Publication History

Received: 20 November 2022

Accepted after revision: 17 July 2023

Article published online:
14 November 2023

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