Complete Pathologic Response With Pembrolizumab and Enfortumab Vedotin in Urothelial Carcinoma of the Upper Urinary Tract

• Published in: JIM - high impact case reports Vol. 12; p. 23247096241257333
• Main Authors: Chan, Kok Hoe, Shu, Tung, Al Shaarani, Majd, Cen, Putao
• Format: Journal Article
• Language: English
• Published: United States SAGE Publications 01-01-2024; SAGE Publishing
• Subjects: Aged, 80 and over; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized - therapeutic use; Antineoplastic Agents, Immunological - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carcinoma, Transitional Cell - drug therapy; Carcinoma, Transitional Cell - pathology; Case Report; Female; Humans; Kidney Neoplasms - drug therapy; Kidney Neoplasms - pathology; Kidney Pelvis - pathology; Neoadjuvant Therapy; Nephroureterectomy; pembrolizumab; neoadjuvant; upper tract urothelial carcinoma; enfortumab vedotin
• ISSN: 2324-7096; 2324-7096
• DOI: 10.1177/23247096241257333

Urothelial carcinoma of the upper urinary tract (UTUC) presents a significant clinical challenge, often requiring aggressive surgical intervention for optimal management. We present a case of an 84-year-old woman with recurrent high-grade papillary UTUC of the left renal pelvis, refractory to prior endourologic interventions, who underwent neoadjuvant treatment with pembrolizumab and enfortumab vedotin (Pembro/EV) due to contraindications to cisplatin therapy. Following a favorable response to neoadjuvant therapy, the patient underwent laparoscopic left radical nephroureterectomy, achieving a pathologic complete response. We discuss the utility of Pembro/EV in the perioperative management of patients with UTUC, particularly in those ineligible for cisplatin-based therapy. In addition, we highlight the potential role of somatic mutation testing and the integration of novel therapeutic agents such as olaparib in personalized treatment strategies for UTUC. This case underscores the importance of exploring innovative treatment approaches and optimizing patient selection for kidney preservation strategies in the management of UTUC. Further research and clinical trials are warranted to elucidate the full therapeutic potential of Pembro/EV and other emerging therapies in this setting.