Abstract
INTRODUCTION: Enfortumab vedotin is a standard therapy for advanced urothelial carcinoma, but its efficacy may be limited by acquired resistance and spatial heterogeneity of Nectin-4 expression. CASE PRESENTATION: We report the case of a 76-year-old woman with cT3N2M0 left renal pelvic urothelial carcinoma that was treated with first-line chemotherapy, followed by pembrolizumab, and subsequently enfortumab vedotin. After 16 cycles of enfortumab vedotin, lymph node metastases remained shrunk, but isolated progression of the primary tumor occurred. Salvage nephroureterectomy was therefore performed, and the patient has remained recurrence-free for one year postoperatively. Immunohistochemistry showed a marked decline in Nectin-4 expression in the resected tumor compared with at the time of the initial biopsy. CONCLUSION: This case highlights the potential role of surgery for localized progression during enfortumab vedotin therapy. Nectin-4 reassessment may be considered selectively at decision-changing junctures when results are likely to alter management.