Case 2025: Ines (expert opinion by B. Szabados)

Ines, 69 years old, has her own atelier. Over the years, countless tourists have unleashed their creativity during her tile-painting workshops, but her greatest pride is her latest group of adolescents who mastered the challenging art of tile-making after an intensive course.

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

Assessment summary:

• 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

Enfortumab vedotin (EV) + pembrolizumab was started; however, on day 15 of the 1^st cycle, the patient presented with pruritus and erythematous macules on the lower legs and soles, covering 20% of the body surface area.

Dermatologic assessment:

• Grade 2 non-specific maculopapular rash, treated with topical corticosteroids, oral antihistamines and emollients
• No improvement, nor worsening after 1 week
• Dermatologist: likely attributable to EV

The patient continues to receive topical corticosteroids, oral antihistamines and emollients. EV + pembrolizumab was withheld and 3 weeks later the skin reaction improved to grade 1.