PDF(Pubmed)
Abstract：
The increasing incidence of urothelial carcinoma, coupled with advancements in its therapeutic landscape, has resulted in improved survival rates for patients. This, in turn, has led to a growing population of patients requiring specialized oncological care, with Enfortumab vedotin (EV) emerging as a pivotal treatment for metastatic urothelial carcinoma. While EV is associated with hyperglycemia, ketoacidosis is exceedingly rare. To the best of our knowledge, the link between EV and hemophagocytic lymphohistiocytosis (HLH) has not yet been explored. A 56-year-old patient diagnosed with metastatic urothelial carcinoma underwent EV treatment as a third-line treatment after progression following treatment with cisplatin/gemcitabine and pembrolizumab. Notably, after receiving two doses of EV, the patient exhibited refractory insulin resistance, leading to ketoacidosis. Subsequently, HLH emerged, necessitating a treatment regimen involving dexamethasone and etoposide. Despite intensive efforts, the patient experienced septic shock, resulting in death. The present case report highlights refractory insulin resistance and ketoacidosis, followed by reactive HLH, in the context of EV therapy. The limited literature on these complications demonstrates the need for further research to improve the understanding of the underlying mechanisms. With growing evidence of the efficacy of EV and evolving survival rates in urothelial carcinoma, healthcare professionals must remain vigilant for potential adverse effects, ensuring early recognition and optimal patient care.
摘要：
尿路上皮癌的发病率增加，再加上其治疗领域的进步，提高了患者的生存率。这个,反过来,导致越来越多的患者需要专门的肿瘤治疗，Enfortumabvedotin（EV）成为转移性尿路上皮癌的关键治疗方法。虽然EV与高血糖有关，酮症酸中毒极为罕见。据我们所知,EV与噬血细胞性淋巴组织细胞增生症（HLH）之间的联系尚未被研究。一名被诊断患有转移性尿路上皮癌的56岁患者在使用顺铂/吉西他滨和派姆单抗治疗后进展后接受了EV治疗作为三线治疗。值得注意的是,在接受两剂EV后，患者表现出难治性胰岛素抵抗，导致酮症酸中毒.随后，HLH出现了，需要涉及地塞米松和依托泊苷的治疗方案。尽管付出了巨大的努力，患者经历了脓毒性休克,导致死亡。本病例报告强调了难治性胰岛素抵抗和酮症酸中毒，其次是反应性HLH，在EV治疗的背景下。关于这些并发症的有限文献表明，需要进一步研究以提高对潜在机制的理解。随着越来越多的证据表明EV的疗效和尿路上皮癌中生存率的变化，医疗保健专业人员必须对潜在的不利影响保持警惕，确保早期识别和最佳的病人护理。
