Enfortumab Vedotin-Induced Febrile Neutropenia and Hyperglycemia Successfully Treated with Multidisciplinary Treatment Including Continuous Hemodialysis Filtration and Insulin Injection in a Patient with Chemo-Resistant Metastatic Urothelial Carcinoma: A Case Report
Abstract Introduction: Enfortumab vedotin (EV) is an antibody-drug conjugate combining a monoclonal antibody targeting nectin-4 with a highly potent microtubule disrupting agent. EV is expected to be a candidate for the third-line treatment for urothelial carcinoma previously treated with platinum-b...
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| Veröffentlicht in: | Case reports in oncology 2024-01, Vol.17 (1), p.891-899 |
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| creator | Otsuka, Ayatsugu Sawada, Norifumi Suda, Ryosuke Yano, Fumiakira Osada, Takuya Otake, Yuko Shimura, Hiroshi Mochizuki, Takanori Harada, Daiki Goto, Junko Watanabe, Tomomi Hosokawa, Tadatsugu Kira, Satoru Tsuchiya, Kyoichiro Moriguchi, Takeshi Mitsui, Takahiko |
| description | Abstract
Introduction: Enfortumab vedotin (EV) is an antibody-drug conjugate combining a monoclonal antibody targeting nectin-4 with a highly potent microtubule disrupting agent. EV is expected to be a candidate for the third-line treatment for urothelial carcinoma previously treated with platinum-based chemotherapy and PD-1/PD-L1 inhibitors. Very few cases of patients experienced hyperglycemia of unknown cause. Case Presentation: We describe a 72-year-old Asian man with mild obesity, type 2 diabetes, hyperlipidemia, hypertension, and chemo-resistant metastatic urothelial carcinoma. He developed hyperglycemia and febrile neutropenia after 3 doses of EV. He had hyperglycemia of 489 mg/dL and was started on continuous intravenous insulin infusion (CVII). The patient’s intravenous insulin requirements peaked at 316 units per day. He also developed febrile neutropenia and consequent sepsis caused acute kidney injury. Continuous hemodialysis filtration (CHDF) together with antibiotics were started to treat the septic condition. The blood glucose level gradually decreased after CHDF treatment and CHDF was continued for 14 days. The timing of liberation from CHDF correlated with the elimination half-life of EV of 3.4 days. CVII was treated for 26 days and the patient was finally released from the intensive care unit. Conclusion: This case indicates that the uncontrollable hyperglycemia induced by EV during metastatic urothelial carcinoma treatment is effectively managed with CVII and CHDF until the elimination of the adverse effect of EV. |
| doi_str_mv | 10.1159/000540354 |
| format | Article |
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Introduction: Enfortumab vedotin (EV) is an antibody-drug conjugate combining a monoclonal antibody targeting nectin-4 with a highly potent microtubule disrupting agent. EV is expected to be a candidate for the third-line treatment for urothelial carcinoma previously treated with platinum-based chemotherapy and PD-1/PD-L1 inhibitors. Very few cases of patients experienced hyperglycemia of unknown cause. Case Presentation: We describe a 72-year-old Asian man with mild obesity, type 2 diabetes, hyperlipidemia, hypertension, and chemo-resistant metastatic urothelial carcinoma. He developed hyperglycemia and febrile neutropenia after 3 doses of EV. He had hyperglycemia of 489 mg/dL and was started on continuous intravenous insulin infusion (CVII). The patient’s intravenous insulin requirements peaked at 316 units per day. He also developed febrile neutropenia and consequent sepsis caused acute kidney injury. Continuous hemodialysis filtration (CHDF) together with antibiotics were started to treat the septic condition. The blood glucose level gradually decreased after CHDF treatment and CHDF was continued for 14 days. The timing of liberation from CHDF correlated with the elimination half-life of EV of 3.4 days. CVII was treated for 26 days and the patient was finally released from the intensive care unit. Conclusion: This case indicates that the uncontrollable hyperglycemia induced by EV during metastatic urothelial carcinoma treatment is effectively managed with CVII and CHDF until the elimination of the adverse effect of EV.</description><identifier>ISSN: 1662-6575</identifier><identifier>EISSN: 1662-6575</identifier><identifier>DOI: 10.1159/000540354</identifier><identifier>PMID: 39144238</identifier><language>eng</language><publisher>Basel, Switzerland: S. Karger AG</publisher><subject>Acidosis ; Antibodies ; Bladder ; Cancer ; Case Report ; Case reports ; chemo-resistant urothelial carcinoma ; Chemotherapy ; continuous hemodialysis filtration ; continuous venous insulin injection ; Creatinine ; Diabetes ; Diabetic ketoacidosis ; Drug dosages ; enfortumab vedotin ; Fasting ; Glucose ; Hemodialysis ; Hemoglobin ; Hyperglycemia ; Insulin ; Metastasis ; Multiple organ dysfunction syndrome ; Neutropenia ; Oncology ; Patients ; Peptides ; Peripheral neuropathy ; Urological surgery</subject><ispartof>Case reports in oncology, 2024-01, Vol.17 (1), p.891-899</ispartof><rights>2024 The Author(s). Published by S. Karger AG, Basel</rights><rights>2024 The Author(s). Published by S. Karger AG, Basel.</rights><rights>2024 The Author(s). Published by S. Karger AG, Basel. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the associated terms available at: https://uk.sagepub.com/en-gb/eur/reusing-open-access-and-sage-choice-content</rights><rights>2024 The Author(s). Published by S. Karger AG, Basel 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c409t-3115f7a6858a0c35347a42a0e44938b34f08388cf72b2994781c16f4957885363</cites><orcidid>0000-0002-1634-0347</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11324273/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11324273/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,27612,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39144238$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Otsuka, Ayatsugu</creatorcontrib><creatorcontrib>Sawada, Norifumi</creatorcontrib><creatorcontrib>Suda, Ryosuke</creatorcontrib><creatorcontrib>Yano, Fumiakira</creatorcontrib><creatorcontrib>Osada, Takuya</creatorcontrib><creatorcontrib>Otake, Yuko</creatorcontrib><creatorcontrib>Shimura, Hiroshi</creatorcontrib><creatorcontrib>Mochizuki, Takanori</creatorcontrib><creatorcontrib>Harada, Daiki</creatorcontrib><creatorcontrib>Goto, Junko</creatorcontrib><creatorcontrib>Watanabe, Tomomi</creatorcontrib><creatorcontrib>Hosokawa, Tadatsugu</creatorcontrib><creatorcontrib>Kira, Satoru</creatorcontrib><creatorcontrib>Tsuchiya, Kyoichiro</creatorcontrib><creatorcontrib>Moriguchi, Takeshi</creatorcontrib><creatorcontrib>Mitsui, Takahiko</creatorcontrib><title>Enfortumab Vedotin-Induced Febrile Neutropenia and Hyperglycemia Successfully Treated with Multidisciplinary Treatment Including Continuous Hemodialysis Filtration and Insulin Injection in a Patient with Chemo-Resistant Metastatic Urothelial Carcinoma: A Case Report</title><title>Case reports in oncology</title><addtitle>Case Rep Oncol</addtitle><description>Abstract
Introduction: Enfortumab vedotin (EV) is an antibody-drug conjugate combining a monoclonal antibody targeting nectin-4 with a highly potent microtubule disrupting agent. EV is expected to be a candidate for the third-line treatment for urothelial carcinoma previously treated with platinum-based chemotherapy and PD-1/PD-L1 inhibitors. Very few cases of patients experienced hyperglycemia of unknown cause. Case Presentation: We describe a 72-year-old Asian man with mild obesity, type 2 diabetes, hyperlipidemia, hypertension, and chemo-resistant metastatic urothelial carcinoma. He developed hyperglycemia and febrile neutropenia after 3 doses of EV. He had hyperglycemia of 489 mg/dL and was started on continuous intravenous insulin infusion (CVII). The patient’s intravenous insulin requirements peaked at 316 units per day. He also developed febrile neutropenia and consequent sepsis caused acute kidney injury. Continuous hemodialysis filtration (CHDF) together with antibiotics were started to treat the septic condition. The blood glucose level gradually decreased after CHDF treatment and CHDF was continued for 14 days. The timing of liberation from CHDF correlated with the elimination half-life of EV of 3.4 days. CVII was treated for 26 days and the patient was finally released from the intensive care unit. Conclusion: This case indicates that the uncontrollable hyperglycemia induced by EV during metastatic urothelial carcinoma treatment is effectively managed with CVII and CHDF until the elimination of the adverse effect of EV.</description><subject>Acidosis</subject><subject>Antibodies</subject><subject>Bladder</subject><subject>Cancer</subject><subject>Case Report</subject><subject>Case reports</subject><subject>chemo-resistant urothelial carcinoma</subject><subject>Chemotherapy</subject><subject>continuous hemodialysis filtration</subject><subject>continuous venous insulin injection</subject><subject>Creatinine</subject><subject>Diabetes</subject><subject>Diabetic ketoacidosis</subject><subject>Drug dosages</subject><subject>enfortumab vedotin</subject><subject>Fasting</subject><subject>Glucose</subject><subject>Hemodialysis</subject><subject>Hemoglobin</subject><subject>Hyperglycemia</subject><subject>Insulin</subject><subject>Metastasis</subject><subject>Multiple organ dysfunction syndrome</subject><subject>Neutropenia</subject><subject>Oncology</subject><subject>Patients</subject><subject>Peptides</subject><subject>Peripheral neuropathy</subject><subject>Urological surgery</subject><issn>1662-6575</issn><issn>1662-6575</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>M--</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNptkk1v1DAQhgMC0Q84cEfIUi9wWLBjJ3F6QdWqS1dqKSot18hxJrteHDv4A7T_Hu9uWbWIk-2Zd555NZ4se03wB0KK-iPGuGCYFuxpdkjKMp-URVU8e3A_yI68X2Fc1kVZvMgOaE0Yyyk_fHJ0bnrrQhxEi75DZ4Myk7npooQOzaB1SgP6AjE4O4JRAgnToYv1CG6h1xKGFPkWpQTv-6j1Gt06ECGV_lZhia6iDqpTXqpRKyPcfXoAE9DcSB07ZRZoak1qGm306AIG2ymh1155NFM6OBGUNdumc-NjoqRzBXIbTQ-BvibFhrdtOF0mwOQGUnkQKXgFQaRbUBLdORuWoBMcTYWTythBnKKz9PCAbmBMM3iZPe-F9vDq_jzO7mbnt9OLyeX15_n07HIiGa7DhKaR95UoecEFlrSgrBIsFxgYqylvKesxp5zLvsrbvK5ZxYkkZc_qouK8oCU9zuY7bmfFqhmdGtJoGitUsw1Yt2iES541NNC2BFqCW2A5o0TWuOBlXwMlnEnWksT6tGONsR2gk2kUTuhH0McZo5bNwv5qCKE5yyuaCO_uCc7-jOBDM6QfA62FgfQnDcU1JRWrqo3xk3-kKxudSbNqKKEkrzkhG0vvdyrprPcO-r0bgpvNujb7dU3atw_t75V_9zMJ3uwEP4RbgNsL9vUn_01Pb653imbsevoHWmL-_w</recordid><startdate>20240101</startdate><enddate>20240101</enddate><creator>Otsuka, Ayatsugu</creator><creator>Sawada, Norifumi</creator><creator>Suda, Ryosuke</creator><creator>Yano, Fumiakira</creator><creator>Osada, Takuya</creator><creator>Otake, Yuko</creator><creator>Shimura, Hiroshi</creator><creator>Mochizuki, Takanori</creator><creator>Harada, Daiki</creator><creator>Goto, Junko</creator><creator>Watanabe, Tomomi</creator><creator>Hosokawa, Tadatsugu</creator><creator>Kira, Satoru</creator><creator>Tsuchiya, Kyoichiro</creator><creator>Moriguchi, Takeshi</creator><creator>Mitsui, Takahiko</creator><general>S. Karger AG</general><general>Karger Publishers</general><scope>M--</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-1634-0347</orcidid></search><sort><creationdate>20240101</creationdate><title>Enfortumab Vedotin-Induced Febrile Neutropenia and Hyperglycemia Successfully Treated with Multidisciplinary Treatment Including Continuous Hemodialysis Filtration and Insulin Injection in a Patient with Chemo-Resistant Metastatic Urothelial Carcinoma: A Case Report</title><author>Otsuka, Ayatsugu ; Sawada, Norifumi ; Suda, Ryosuke ; Yano, Fumiakira ; Osada, Takuya ; Otake, Yuko ; Shimura, Hiroshi ; Mochizuki, Takanori ; Harada, Daiki ; Goto, Junko ; Watanabe, Tomomi ; Hosokawa, Tadatsugu ; Kira, Satoru ; Tsuchiya, Kyoichiro ; Moriguchi, Takeshi ; Mitsui, Takahiko</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c409t-3115f7a6858a0c35347a42a0e44938b34f08388cf72b2994781c16f4957885363</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Acidosis</topic><topic>Antibodies</topic><topic>Bladder</topic><topic>Cancer</topic><topic>Case Report</topic><topic>Case reports</topic><topic>chemo-resistant urothelial carcinoma</topic><topic>Chemotherapy</topic><topic>continuous hemodialysis filtration</topic><topic>continuous venous insulin injection</topic><topic>Creatinine</topic><topic>Diabetes</topic><topic>Diabetic ketoacidosis</topic><topic>Drug dosages</topic><topic>enfortumab vedotin</topic><topic>Fasting</topic><topic>Glucose</topic><topic>Hemodialysis</topic><topic>Hemoglobin</topic><topic>Hyperglycemia</topic><topic>Insulin</topic><topic>Metastasis</topic><topic>Multiple organ dysfunction syndrome</topic><topic>Neutropenia</topic><topic>Oncology</topic><topic>Patients</topic><topic>Peptides</topic><topic>Peripheral neuropathy</topic><topic>Urological surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Otsuka, Ayatsugu</creatorcontrib><creatorcontrib>Sawada, Norifumi</creatorcontrib><creatorcontrib>Suda, Ryosuke</creatorcontrib><creatorcontrib>Yano, Fumiakira</creatorcontrib><creatorcontrib>Osada, Takuya</creatorcontrib><creatorcontrib>Otake, Yuko</creatorcontrib><creatorcontrib>Shimura, Hiroshi</creatorcontrib><creatorcontrib>Mochizuki, Takanori</creatorcontrib><creatorcontrib>Harada, Daiki</creatorcontrib><creatorcontrib>Goto, Junko</creatorcontrib><creatorcontrib>Watanabe, Tomomi</creatorcontrib><creatorcontrib>Hosokawa, Tadatsugu</creatorcontrib><creatorcontrib>Kira, Satoru</creatorcontrib><creatorcontrib>Tsuchiya, Kyoichiro</creatorcontrib><creatorcontrib>Moriguchi, Takeshi</creatorcontrib><creatorcontrib>Mitsui, Takahiko</creatorcontrib><collection>Karger Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Case reports in oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Otsuka, Ayatsugu</au><au>Sawada, Norifumi</au><au>Suda, Ryosuke</au><au>Yano, Fumiakira</au><au>Osada, Takuya</au><au>Otake, Yuko</au><au>Shimura, Hiroshi</au><au>Mochizuki, Takanori</au><au>Harada, Daiki</au><au>Goto, Junko</au><au>Watanabe, Tomomi</au><au>Hosokawa, Tadatsugu</au><au>Kira, Satoru</au><au>Tsuchiya, Kyoichiro</au><au>Moriguchi, Takeshi</au><au>Mitsui, Takahiko</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Enfortumab Vedotin-Induced Febrile Neutropenia and Hyperglycemia Successfully Treated with Multidisciplinary Treatment Including Continuous Hemodialysis Filtration and Insulin Injection in a Patient with Chemo-Resistant Metastatic Urothelial Carcinoma: A Case Report</atitle><jtitle>Case reports in oncology</jtitle><addtitle>Case Rep Oncol</addtitle><date>2024-01-01</date><risdate>2024</risdate><volume>17</volume><issue>1</issue><spage>891</spage><epage>899</epage><pages>891-899</pages><issn>1662-6575</issn><eissn>1662-6575</eissn><abstract>Abstract
Introduction: Enfortumab vedotin (EV) is an antibody-drug conjugate combining a monoclonal antibody targeting nectin-4 with a highly potent microtubule disrupting agent. EV is expected to be a candidate for the third-line treatment for urothelial carcinoma previously treated with platinum-based chemotherapy and PD-1/PD-L1 inhibitors. Very few cases of patients experienced hyperglycemia of unknown cause. Case Presentation: We describe a 72-year-old Asian man with mild obesity, type 2 diabetes, hyperlipidemia, hypertension, and chemo-resistant metastatic urothelial carcinoma. He developed hyperglycemia and febrile neutropenia after 3 doses of EV. He had hyperglycemia of 489 mg/dL and was started on continuous intravenous insulin infusion (CVII). The patient’s intravenous insulin requirements peaked at 316 units per day. He also developed febrile neutropenia and consequent sepsis caused acute kidney injury. Continuous hemodialysis filtration (CHDF) together with antibiotics were started to treat the septic condition. The blood glucose level gradually decreased after CHDF treatment and CHDF was continued for 14 days. The timing of liberation from CHDF correlated with the elimination half-life of EV of 3.4 days. CVII was treated for 26 days and the patient was finally released from the intensive care unit. Conclusion: This case indicates that the uncontrollable hyperglycemia induced by EV during metastatic urothelial carcinoma treatment is effectively managed with CVII and CHDF until the elimination of the adverse effect of EV.</abstract><cop>Basel, Switzerland</cop><pub>S. Karger AG</pub><pmid>39144238</pmid><doi>10.1159/000540354</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-1634-0347</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Acidosis Antibodies Bladder Cancer Case Report Case reports chemo-resistant urothelial carcinoma Chemotherapy continuous hemodialysis filtration continuous venous insulin injection Creatinine Diabetes Diabetic ketoacidosis Drug dosages enfortumab vedotin Fasting Glucose Hemodialysis Hemoglobin Hyperglycemia Insulin Metastasis Multiple organ dysfunction syndrome Neutropenia Oncology Patients Peptides Peripheral neuropathy Urological surgery |
| title | Enfortumab Vedotin-Induced Febrile Neutropenia and Hyperglycemia Successfully Treated with Multidisciplinary Treatment Including Continuous Hemodialysis Filtration and Insulin Injection in a Patient with Chemo-Resistant Metastatic Urothelial Carcinoma: A Case Report |
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