François (70 years old)

70-year-old François never misses the opening ceremony of the Olympic games. This year he is very excited to see them live in his home city.

He is diagnosed with metastatic UCa of bladder during a workup for dysuria.

Assessment summary:

• Former smoker (30 pack years)
• Medical history: controlled type 2 diabetes mellitus, dry skin
• CT scan of chest, abdomen and pelvis: bone and lung metastases, biopsy compatible with UCa
• ECOG PS: 1
• No peripheral neuropathy
• Audiometric hearing loss: grade 1
• GFR: 90 ml/min
• Cardiac ejection fraction: 60%
• Normal blood glucose levels
• FGFR2/3 alteration status in metastatic biopsy specimen: activating FGFR3 alteration

Treatment with enfortumab vedotin (EV) + pembrolizumab was started; however, on day 15 of the first cycle of therapy, the patient presented with pruritus. Physical examination revealed erythematous macules on the lower legs and soles, covering 20% of the body surface area. After dermatologic follow-up, the patient received topical corticosteroids, oral antihistamines and emollients for grade 2 non-specific maculopapular rash. However, symptoms did not improve, nor worsen after 1 week. The dermatologist concludes that the rash is not typical of an immune-related skin reaction and that it is likely attributable to EV.