病例報告-肌肉侵襲性膀胱癌患者於Enfortumab vedotin與Pembrolizumab合併治療後接受同步化學放射治療

張家郡¹、張兆祥^1,2

¹中國醫藥大學附設醫院 泌尿部；²中國醫藥大學 醫學系

Case Report: Muscle-Invasive Bladder Urothelial Carcinoma Treated with Concurrent Chemoradiotherapy Following Systemic Therapy with Enfortumab Vedotin and Pembrolizumab

Jia-Jyun Jhang¹, Chao-Hsiang Chang^1,2

¹Department of Urology, China Medical University Hospital, Taichung, Taiwan; ² School of Medicine, China Medical University, Taichung, Taiwan

Purpose: Bladder preserving procedures are an emerging treatment strategy for muscle invasive bladder urothelial carcinoma (MIBC). Concurrent chemoradiotherapy (CCRT) following systemic therapy is one approach to bladder preservation. Recent trials have shown that enfortumab vedotin (EV) combined with pembrolizumab demonstrates an outstanding response rate in advanced-stage urothelial carcinoma (UC). We here present a patient who received CCRT after systemic therapy with EV and Pembrolizumab.

Case presentation: A 64-year-old male presented with hematuria for two weeks and was diagnosed with MIBC. Although radical cystectomy was recommended, the patient opted for a bladder-preserving approach. He then received systemic therapy on a 3-weeks cycle of EV 60mg on day 1, day 8 and Pembrolizumab 200mg on day 1. After 4 cycles of the treatment, maximal transurethral resection of the bladder tumor (TURBT) showed no evidence of residual tumor. Given the absence of hydronephrosis and concurrent carcinoma in situ, we proceeded with CCRT. The patient received radiation therapy totaling 6400 cGy in 32 fractions: 23 fractions covering the whole bladder and pelvic lymph nodes, and 9 fractions targeting the bladder alone. Weekly cisplatin 600 mg was administered as a radiosensitizing agent. 8 months after completing the treatment both MRI and cystoscopy showed no evidence of tumor recurrence. There were also no intolerable adverse events.

Conclusions: Our study highlights an alternative strategy for bladder-preserving treatment. Oncological outcome for CCRT vary across different studies and multiple trials are ongoing to identify more effective systemic therapy combinations. Given the high objective response rate observed in previous trials, we believe EV may play a significant role in future systemic therapy for CCRT.