Enfortumab vedotin plus pembrolizumab (EVP) is a first-line treatment for metastatic urothelial carcinoma (mUC) based on the EV302 trial; however, patients receiving hemodialysis were excluded from this study. Therefore, evidence regarding the safety and efficacy of this combination therapy in patients undergoing hemodialysis is insufficient. We present a case of mUC in a patient undergoing hemodialysis treated with EVP. A 72-year-old man underwent total urinary tract extirpation for high-grade UC and subsequently required hemodialysis. Four years later, he developed right ischial metastasis. First-line systemic therapy with enfortumab vedotin (EV) 1.25 mg/kg plus pembrolizumab (200 mg) was initiated, with infusions scheduled on nonhemodialysis days. The patient completed three cycles without any dose reduction. Treatment-related adverse events were limited to grade 2 pruritus and grade 1 fatigue, with no grade ≥3 adverse events. Restaging computed tomography after three cycles revealed enlargement of the ischial lesion, indicating progressive disease, and systemic therapy was discontinued. A standard dose of EVP can be safely administered to patients on hemodialysis, with manageable toxicities comparable to those observed in nonhemodialysis patients. Although its antitumor efficacy was not confirmed, our experience suggests that EVP may remain a therapeutic option for selected dialysis patients with mUC.
Mizuno et al. (Mon,) studied this question.
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