抗體藥物複合體Enfortumab Vedotin用於晚期泌尿上皮細胞癌治療：系列個案報告及文獻回顧

何岩¹、溫玉清^1,2、李良明¹、林雍偉^1,2、林克勳¹、蕭志豪^1,2、許軒豪¹、賴宗豪¹、鍾卓興¹

臺北市立萬芳醫院-委託臺北醫學大學辦理 泌尿科¹

臺北醫學大學醫學院醫學系 泌尿學科²

Enfortumab Vedotin in Treatment of Advanced Urothelial Carcinoma: A Case Series and Review of the Literature

Yen Ho¹, Yu-Ching Wen^1,2, Liang-Ming Lee¹, Yung-Wei Lin^1,2, Ke-Hsun Lin¹, Chi-Hao Hsiao^1,2, Syuan-Hao Syu¹, Benjamin Lai Chung Howe¹, Cho-Hsing Chung¹

Department of Urology, Wan Fang Hospital, Taipei Medical University¹

Department of Urology, School of Medicine, College of Medicine, Taipei Medical University²

Purpose: Despite cisplatin-based chemotherapy being the standard treatment for locally advanced or metastatic urothelial carcinoma, patients still experience low overall survival rates. Enfortumab vedotin has demonstrated improved survival outcomes compared to chemotherapy. Here, we present our institution's experience with three such cases and provide an updated literature review on the subject.

Materials and Methods: A retrospective review of medical records ensued to scrutinize the clinical and radiological progressions in 3 cases of urothelial carcinoma patients treated with Enfortumab Vedotin-ejfv were accessible for examination at our institution between 2023 and 2024.

Results: We reported three cases of advanced urothelial carcinoma refractory to prior cisplatin-based chemotherapy. While two patients received combination therapy with enfortumab vedotin and pembrolizumab, one of them modified treatment frequency due to financial constraints. The remaining patient underwent enfortumab vedotin monotherapy as per standard protocol. Notably, one patient displayed a partial response, with significant reduction in liver metastasis evident after just one cycle of combination therapy. The remaining two patients exhibited stable disease on imaging. In terms of safety, a generalized papular eruption led to a one-week postponement of the third dose for the patient on monotherapy. Symptoms subsided after referring the patient to dermatologist and received topical and oral steroid treatment. One of the patients receiving combination therapy showed peripheral skin pigmentations without sensory deficits. No other significant adverse events, classified as Clavien-Dindo grade III or higher, were observed, including those mentioned in previous studies such as peripheral sensory neuropathy or alopecia. Unfortunately, one patient succumbed to pneumonia six weeks after initiating enfortumab vedotin treatment, an occurrence deemed unrelated to the cancer or its treatment.

Conclusions: Enfortumab vedotin, with or without pembrolizumab, exhibited a well-tolerated safety profile, with careful monitoring for dermatological manifestations. Patients demonstrated either tumor regression or maintained disease stability following treatment; nevertheless, ongoing surveillance is warranted. To our understanding, this series stands as the singular documentation delineating the efficacy and safety profile of enfortumab vedotin in advanced urothelial carcinoma within the Taiwanese context so far.