EV-103: Enfortumab Vedotin Plus Pembrolizumab in Urothelial Carcinoma
Dr. Tagawa offers his initial impressions on the second patient case and discusses data on enfortumab vedotin plus pembrolizumab for patients with urothelial carcinoma.
EP: 1.Patient Profile 1: A 72-Year-Old With Metastatic Urothelial Carcinoma
EP: 2.Overview of Urothelial Carcinoma
EP: 3.Key Treatment Data in Urothelial Carcinoma
EP: 4.Urothelial Carcinoma: Adverse Events From Sacituzumab Govitecan
EP: 5.Patient Profile 2: A 76-Year-Old With Locally Advanced, Resectable Urothelial Carcinoma
EP: 6.EV-103: Enfortumab Vedotin Plus Pembrolizumab in Urothelial Carcinoma
EP: 7.Urothelial Carcinoma: Safety Profile of Enfortumab Vedotin and Pembrolizumab
EP: 8.Clinical Insights on Evolving Treatment Landscape in Urothelial Carcinoma
Case 2: A 76-Year Old Man with Locally Advanced, Resectable Urothelial Carcinoma
Initial Clinical Presentation:
- A 76-year-old man presented to the clinic with complaints of dizziness and hematuria.
- PMH: hypercholesterolemia (well controlled with medication) and mild COPD.
- SH: Patient does not smoke or drink alcohol.
Initial Clinical Workup:
- CT Imaging: Chest, abdomen, and pelvis revealed a 3.5-cm mass in the bladder and multiple liver metastases.
- ECOG PS 1
- eGFR > 60 mL/min (cisplatin-eligible kidney function)
- Lung Biopsy confirmed stage IV urothelial carcinoma.
- Molecular testing: FGFR2/3 mutation and fusion negative
Treatment and Disease Progression:
- Patient is initiated with neoadjuvant gemcitabine plus cisplatin for 4 cycles.
- He achieved a partial response following chemotherapy.
- Following neoadjuvant therapy, the patient undergoes surgical resection of the tumor.
- While discussed with his oncology care team, the patient did not receive maintenance treatment.
- ·6 months following surgery, patient demonstrates disease progression based after routine follow up and repeat imaging.
- Patient progresses to muscle-invasive metastatic urothelial carcinoma.
- ·Patient is started on combination pembrolizumab plus enfortumab vedotin-ejfv.
- Pembrolizumab 200 mg IV every 3 weeks; enfortumab 1.25 mg/kg IV infusion over 30 minutes on Days 1 and 8 for every 21-day cycle.
- 12 hours post-infusion, the patient developed a maculopapular rash and was improved with supportive care (topical hydrocortisone cream).
- Achieves partial response after 6 cycles.
- Following initial systemic therapy, patient is evaluated in a routine follow up visit and demonstrates further disease progression.
- After discussion with his oncology care team, the patient is initiated on sacituzumab govitecan 10 mg/kg IV on D1 and D8 for 21-day cycles.
- 48 hours following start of therapy, patient notices feeling dehydrated and having more frequent bowel movements. His oncologist starts him on oral loperamide to manage his diarrhea. Two days later, the patient’s diarrhea was resolved.
- After discussion with his oncology care team, the patient is initiated on sacituzumab govitecan 10 mg/kg IV on D1 and D8 for 21-day cycles.
Coding Q&A: Billing for female total urethrectomy with complete cystectomy
January 5th 2024"When we think about a typical procedure for performing a radical cystectomy for cancer with an ileal conduit, that would typically involve lymph node dissection, and therefore CPT 51595 would be best chosen to report that combined procedure," write Jonathan Rubenstein, MD, and Mark Painter.
Speaking of Urology Podcast: Dr. Ritch and Dr. Katz discuss new bladder cancer management app
December 7th 2021“It's not a replacement for clinical judgment, obviously. But at the end of the day, the idea is that it shows you what your next steps are based on what the American Urological Association and [Society of Urologic Oncology] guidelines are for non-muscle invasive bladder cancer,” Chad R. Ritch, MD, MBA, FACS.
