Patient Profile 2: A 76-Year-Old With Locally Advanced, Resectable 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

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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.