一名39岁的日本男性患者表现为持续两个月的严重血尿。然而,未观察到患者病史和家族史的相关发现.他被诊断出患有肌肉浸润性膀胱癌,临床分期T2bN0M0。吉西他滨和顺铂四个疗程的新辅助化疗后,肿瘤大小减少约30%。该患者接受了机器人辅助的根治性膀胱切除术,并进行了标准淋巴结清扫术,然后进行了体内回肠导管重建。组织学上,肿瘤被诊断为高级别尿路上皮癌,侵入膀胱周围的脂肪组织并转移到淋巴结,病理分期为ypT3aypN2M0。手术四个月后,检测到多个转移,并立即开始派姆单抗治疗.然而,患者对pembrolizumab无反应.因此,开始使用enfortumabvedotin(EV)进行三线治疗.此后,转移病灶迅速缩小,两个疗程的EV给药后,转移灶几乎消失。尽管在其他部位观察到新的转移,到目前为止还没有再生。随访期间未观察到与EV相关的不良事件。手术18个月后,患者仍然活着,有多个转移。因此,应考虑治疗顺序,以最大限度地提高EV的治疗效果,and,因此,尽早管理EV可能很重要。
A 39-year-old Japanese male patient presented with a chief complaint of gross hematuria persistent for two months. However, no relevant findings in the patient\'s medical and family history were observed. He was diagnosed with muscle-invasive bladder cancer, clinical stage T2bN0M0. After four courses of neoadjuvant chemotherapy with gemcitabine and cisplatin, the tumor size reduced by approximately 30%. The patient underwent robot-assisted radical cystectomy with standard lymph node dissection followed by intracorporeal ileal conduit reconstruction. Histologically, the tumor was diagnosed as a high-grade urothelial carcinoma invading the fatty tissue surrounding the bladder and metastasizing to the lymph nodes, with a pathological stage of ypT3aypN2M0. Four months after surgery, multiple metastases were detected, and treatment with pembrolizumab was initiated immediately. However, the patient did not respond to pembrolizumab. Therefore, a third-line treatment with enfortumab vedotin (EV) was initiated. Thereafter, the metastatic lesion shrank quickly, and the metastatic lesions almost disappeared after two courses of EV administration. Although new metastases were observed at other sites, there has been no regrowth to date. EV-related adverse events were not observed during follow-up. Eighteen months after the surgery, the patient remains alive with multiple metastases. Therefore, the sequence of treatment should be considered to maximize the therapeutic effect of EV, and, consequently, administering EV as early as possible may be important.