Successful Management of Tumor Lysis Syndrome Following Enfortumab Vedotin Plus Pembrolizumab Therapy in Metastatic Urothelial Carcinoma: A Case Report

Q4 Medicine

IJU Case Reports Pub Date : 2025-07-16 DOI:10.1002/iju5.70069

Daigo Takemori, Ryu Shigehisa, Sho Shimasaki, Erika Yamashita, Yoshitaka Kurano, Kaya Atagi, Yuhi Ota, Shinkuro Yamamoto, Hiroto Osakabe, Tomoya Nao, Tsutomu Shimamoto, Hideo Fukuhara, Nobutaka Shimizu, Satoshi Fukata, Shingo Ashida, Keiji Inoue

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Abstract

Introduction

Enfortumab vedotin plus pembrolizumab (EV + P) shows high efficacy in metastatic urothelial carcinoma (mUC), potentially increasing tumor lysis syndrome (TLS) risk.

Case Presentation

A 64-year-old man with mUC underwent surgery and adjuvant nivolumab after neoadjuvant chemotherapy. Five months post-surgery, EV + P was initiated for recurrence with distant metastasis. Non-contrast computed tomography on Day 15 of therapy revealed marked regression of hepatic and pulmonary metastases and significant reduction of the iliac soft tissue mass, with no evidence of infection. The following day, however, laboratory findings were consistent with TLS, followed by hypotension and respiratory failure. He was transferred to the intensive care unit for multidisciplinary supportive management. After stabilization, he was discharged home, and the second cycle of EV + P was completed uneventfully under prophylactic hydration and uric acid–lowering therapy.

Conclusion

Early recognition and timely multidisciplinary management are essential for favorable outcomes in TLS following EV + P therapy in mUC patients.

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在转移性尿路上皮癌中，安可单抗维多汀联合派姆单抗治疗后肿瘤溶解综合征的成功管理：1例报告

Enfortumab vedotin + pembrolizumab （EV + P）在转移性尿路上皮癌（mUC）中显示出很高的疗效，可能增加肿瘤溶解综合征（TLS）的风险。一例64岁男性mUC患者在新辅助化疗后接受手术和辅助纳武单抗治疗。术后5个月，开始EV + P治疗复发伴远处转移。治疗第15天的非对比计算机断层扫描显示肝和肺转移灶明显消退，髂软组织肿块明显缩小，无感染迹象。然而，第二天，实验室结果与TLS一致，随后出现低血压和呼吸衰竭。他被转移到重症监护室进行多学科支持管理。病情稳定后出院，在预防性补水和降尿酸治疗下顺利完成第二周期的EV + P治疗。结论早期识别和及时的多学科管理是mUC患者EV + P治疗后TLS预后良好的关键。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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