PDF(Pubmed)
Abstract：
UNASSIGNED: Enfortumab vedotin (EV) is an antibody-drug conjugate combining a monoclonal antibody targeting nectin-4 with a highly potent microtubule disrupting agent. EV is expected to be a candidate for the third-line treatment for urothelial carcinoma previously treated with platinum-based chemotherapy and PD-1/PD-L1 inhibitors. Very few cases of patients experienced hyperglycemia of unknown cause.
UNASSIGNED: We describe a 72-year-old Asian man with mild obesity, type 2 diabetes, hyperlipidemia, hypertension, and chemo-resistant metastatic urothelial carcinoma. He developed hyperglycemia and febrile neutropenia after 3 doses of EV. He had hyperglycemia of 489 mg/dL and was started on continuous intravenous insulin infusion (CVII). The patient\'s intravenous insulin requirements peaked at 316 units per day. He also developed febrile neutropenia and consequent sepsis caused acute kidney injury. Continuous hemodialysis filtration (CHDF) together with antibiotics were started to treat the septic condition. The blood glucose level gradually decreased after CHDF treatment and CHDF was continued for 14 days. The timing of liberation from CHDF correlated with the elimination half-life of EV of 3.4 days. CVII was treated for 26 days and the patient was finally released from the intensive care unit.
UNASSIGNED: This case indicates that the uncontrollable hyperglycemia induced by EV during metastatic urothelial carcinoma treatment is effectively managed with CVII and CHDF until the elimination of the adverse effect of EV.
UNASSIGNED: We describe a 72-year-old Asian man with mild obesity, type 2 diabetes, hyperlipidemia, hypertension, and chemo-resistant metastatic urothelial carcinoma. He developed hyperglycemia and febrile neutropenia after 3 doses of EV. He had hyperglycemia of 489 mg/dL and was started on continuous intravenous insulin infusion (CVII). The patient\'s intravenous insulin requirements peaked at 316 units per day. He also developed febrile neutropenia and consequent sepsis caused acute kidney injury. Continuous hemodialysis filtration (CHDF) together with antibiotics were started to treat the septic condition. The blood glucose level gradually decreased after CHDF treatment and CHDF was continued for 14 days. The timing of liberation from CHDF correlated with the elimination half-life of EV of 3.4 days. CVII was treated for 26 days and the patient was finally released from the intensive care unit.
UNASSIGNED: This case indicates that the uncontrollable hyperglycemia induced by EV during metastatic urothelial carcinoma treatment is effectively managed with CVII and CHDF until the elimination of the adverse effect of EV.
摘要：
■Enfortumabvedotin（EV）是一种抗体-药物缀合物，将靶向nectin-4的单克隆抗体与高效微管破坏剂结合在一起。EV有望成为先前使用基于铂的化学疗法和PD-1/PD-L1抑制剂治疗的尿路上皮癌的三线治疗的候选药物。极少数患者出现不明原因的高血糖。
■我们描述了一个72岁的亚裔男子，患有轻度肥胖，2型糖尿病,高脂血症,高血压,和化疗耐药的转移性尿路上皮癌。3剂EV后，他出现了高血糖和发热性中性粒细胞减少症。他的高血糖为489mg/dL，并开始连续静脉内胰岛素输注（CVII）。患者的静脉内胰岛素需求达到每天316个单位的峰值。他还出现了发热性中性粒细胞减少症和随之而来的败血症引起的急性肾损伤。开始将持续血液透析过滤（CHDF）与抗生素一起治疗败血症。CHDF治疗后血糖水平逐渐下降，CHDF持续14天。从CHDF中解放出来的时间与EV的消除半衰期为3.4天相关。CVII治疗26天，患者最终从重症监护病房出院。
■这种情况表明，在转移性尿路上皮癌治疗期间由EV引起的无法控制的高血糖得到了CVII和CHDF的有效控制，直到消除EV的不良反应为止。
■我们描述了一个72岁的亚裔男子，患有轻度肥胖，2型糖尿病,高脂血症,高血压,和化疗耐药的转移性尿路上皮癌。3剂EV后，他出现了高血糖和发热性中性粒细胞减少症。他的高血糖为489mg/dL，并开始连续静脉内胰岛素输注（CVII）。患者的静脉内胰岛素需求达到每天316个单位的峰值。他还出现了发热性中性粒细胞减少症和随之而来的败血症引起的急性肾损伤。开始将持续血液透析过滤（CHDF）与抗生素一起治疗败血症。CHDF治疗后血糖水平逐渐下降，CHDF持续14天。从CHDF中解放出来的时间与EV的消除半衰期为3.4天相关。CVII治疗26天，患者最终从重症监护病房出院。
■这种情况表明，在转移性尿路上皮癌治疗期间由EV引起的无法控制的高血糖得到了CVII和CHDF的有效控制，直到消除EV的不良反应为止。
