Extra case 1: Ines (69 years old)

69-year-old Ines never misses the opening ceremony of the Olympic games. This year she is very excited to see them live in her home city.

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

Assessment summary:

• Medical history: controlled type 2 diabetes mellitus, dry skin
• ECOG PS: 1
• CT scan of chest, abdomen and pelvis: lung metastases, biopsy compatible with UCa
• No peripheral neuropathy
• Audiometric hearing loss: grade 1
• GFR: 90 ml/min
• Cardiac ejection fraction: 60%
• Normal blood glucose levels (HbA1c 6.5%; 48 mmol/mol)

Enfortumab vedotin (EV) + pembrolizumab (P) was started:

• Day 1 of cycle 1:
  • Full dose EV+P
• Day 8 of cycle 1:
  • No symptoms
  • Full dose EV
• Day 1 of cycle 2:
  • Symptoms: pruritus and erythematous macules on the lower legs, covering 20% of the body surface area
  • Dermatologic consult:
    • Grade 2 non-specific maculopapular rash
    • Likely attributable to EV
  • Treatment with topical corticosteroids, oral antihistamines and emollients started
  • EV withheld, pembrolizumab continued
• Day 8 of cycle 2:
  • No improvement, nor worsening of skin reaction
  • Topical corticosteroids, oral antihistamines and emollients continued
  • EV withheld
• Day 1 of cycle 3 (current situation):
  • Skin reaction improved to grade 1