PDF(Pubmed)
Abstract：
We report the case of a 68-year-old man who developed a sigmoidorectal fistula after marked response to enfortumab vedotin for advanced bladder cancer. The patient had undergone radical cystectomy with ileal conduit after neoadjuvant chemotherapy. Six months after surgery, local recurrence in the pelvic cavity and multiple lung metastases were found, and the patient was administered pembrolizumab as second-line therapy. Due to worsening local recurrence and suspected invasion of the sigmoid colon and rectum, enfortumab vedotin was initiated as third-line therapy and comprehensive genomic profiling was simultaneously performed. Enfortumab vedotin was remarkably effective, the lung metastases disappeared, and the local recurrent lesion shrank in volume although a sigmoidorectal fistula was found to form through the tumor cavity. Immunohistochemical analysis of the tumor specimens exhibited increased nectin-4 expression. This rare case of metastatic bladder cancer with sigmoidorectal fistula associated with effective enfortumab vedotin therapy suggests that nectin-4 expression and comprehensive genomic profiling might be useful in predicting treatment response to enfortumab vedotin.
摘要：
我们报告了一名68岁男子的病例，该男子在对enfortumabvedotin对晚期膀胱癌有明显反应后发展为乙状结肠直肠瘘。该患者在新辅助化疗后接受了带回肠导管的根治性膀胱切除术。手术后六个月,发现盆腔局部复发和多发肺转移，患者接受派姆单抗作为二线治疗.由于局部复发恶化和怀疑乙状结肠和直肠的侵袭，enfortumabvedotin作为三线治疗开始,同时进行了全面的基因组分析.Enfortumabvedotin非常有效，肺转移消失,尽管发现乙状结肠直肠瘘通过肿瘤腔形成，但局部复发性病变体积缩小。肿瘤标本的免疫组织化学分析显示nectin-4表达增加。这种罕见的转移性膀胱癌合并乙状结肠直肠瘘的病例与有效的enfortumabvedotin治疗相关，表明nectin-4表达和全面的基因组谱分析可能有助于预测对enfortumabvedotin的治疗反应。
