Management of extravasations of enfortumab vedotin and pembrolizumab: a case report and mini review of the current literature.
Hendrik Dinkel, Konstantin E Seifert, Martin Bögemann et al.
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Case in brief
A 56-year-old patient with metastatic urothelial carcinoma developed extravasation of enfortumab vedotin and pembrolizumab during the first treatment cycle after the port catheter dislocated from the cephalic vein. The event caused extensive subcutaneous necrosis in the infraclavicular region, requiring surgical debridement and vacuum-assisted closure, followed by secondary wound healing. The wound healed with a residual scar but no functional impairment or persistent pain. Treatment was resumed through a peripheral venous catheter, and the patient achieved a deep partial response.
What made this case unusual
The report describes central venous extravasation of the combination therapy, classified as CTCAE grade 3, with extensive tissue necrosis requiring surgery.
Diagnostic / clinical pearl
When EV-P extravasation is suspected, consider the potential for severe local tissue injury, particularly from enfortumab vedotin’s cytotoxic payload.