Cavitation of Pulmonary Metastases During Enfortumab Vedotin for Metastatic Ureteral Urothelial Carcinoma

Introduction Enfortumab vedotin (EV), a Nectin‐4–targeted antibody–drug conjugate, is active in previously treated urothelial carcinoma. Cavitation of pulmonary metastases is classically linked to squamous histology or anti‐angiogenic/cytotoxic regimens; rarely reported under EV. Case Presentation A 69‐year‐old woman with upper‐tract urothelial carcinoma developed pulmonary and hepatic metastases. During EV, multiple lung nodules rapidly cavitated into thin‐walled lesions while liver disease shrank. No infectious symptoms; overall survival was 12 months from EV start. Discussion Cavitation likely reflects treatment‐related necrosis once infection and EV‐related pneumonitis are excluded. Diameter‐based criteria can misjudge response when solid nodules cavitate; short‐interval re‐imaging is advisable. Pulmonary response may not ensure systemic control. Conclusion Recognizing EV‐associated cavitation as a response pattern may prevent premature discontinuation of effective therapy and unnecessary antibiotics.