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Case Reports
. 2021 Oct 15;9(5):390-396.
eCollection 2021.

A case report of a patient with plasmacytoid urothelial cancer with significant response to HER2-targeting therapy and enfortumab vedotin

Michael Sun  1 , Ariel Schaap  1 , Brian D Robinson  2 , David M Nanus  1   3 , Scott T Tagawa  1   3
Affiliations
Case Reports

A case report of a patient with plasmacytoid urothelial cancer with significant response to HER2-targeting therapy and enfortumab vedotin

Michael Sun et al. Am J Clin Exp Urol. .

Abstract

In this case report, we present a patient with the rare plasmacytoid variant of urothelial cancer. Notable elements of his course include: complete response to neoadjuvant paclitaxel, gemcitabine, cisplatin, development of metastatic disease to the rectum, sustained disease control with dual HER2 targeting therapy, and subsequent complete response to enfortumab vedotin. Plasmacytoid urothelial cancer accounts for just 1-3% of all urothelial cancer cases and is associated with more aggressive disease, with a propensity for intra-abdominal spread and poor response to neoadjuvant therapy. Preliminary data indicate that the variant may generally have high levels of HER2 expression. We review the history of HER2 targeting in metastatic urothelial cancer, which has included single-agent as well as combination with chemotherapy; there are ongoing biomarker-based clinical trials. Furthermore, we highlight the complete response to enfortumab vedotin. To date, this is the first report of efficacy for enfortumab vedotin in the plasmacytoid variant.

Keywords: Urothelial carcinoma; biomarkers; bladder cancer; plasmacytoid variant.

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Conflict of interest statement

Research funding to Weill Cornell Medicine from Seagen, Gilead, Janssen, Merck, AstraZeneca. Receipt of honoraria from: Janssen, Seagen, Gilead.

Figures

Figure 1
Figure 1
Bladder biopsy with normal urothelium and irregular nests of atypical cells deep within the lamina propria.
Figure 2
Figure 2
Discohesive carcinoma cells in clusters and dispersed singly throughout the lamina propria. The cells have eccentric round nuclei with eosinophilic cytoplasm, resembling plasma cells.
Figure 3
Figure 3
PET/CT demonstrating hypermetabolic rectosigmoid metastases (SUVmax 21.3).
See this image and copyright information in PMC

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