Rapid Regression of Rare Sub-Cutaneous Metastasis in Urothelial Carcinoma Patient Treated with Enfortumab Vedotin Plus Pembrolizumab: A Case Report

Bladder cancer is a common urological malignancy, predominantly affecting older adults, and metastatic disease is associated with poor prognosis. We present the case of a 70-year-old woman with metastatic urothelial carcinoma presenting as a right subcutaneous axillary mass. First-line treatment with enfortumab vedotin, an anti–Nectin-4 antibody–drug conjugate, combined with the PD-1 inhibitor pembrolizumab resulted in a rapid and clinically significant regression of the lesion. This case illustrates a rare presentation of subcutaneous metastasis in urothelial carcinoma, suggestive of aggressive tumor biology. The dramatic response to enfortumab vedotin plus pembrolizumab underscores the potential efficacy of this combination in patient's ineligible for cisplatin-based chemotherapy. Early systemic therapy proved effective in controlling metastatic progression, even in the set setting of renal impairment and advanced age.