Concurrent erythema multiforme and psoriasiform eruption during enfortumab vedotin plus pembrolizumab therapy for advanced urothelial carcinoma
- 1Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico Fondazione G. Pascale, Naples, Italy
- 2School of Medicine, UniCamillus “Saint Camillus International” University of Health Sciences, Rome, Italy
- 3Oncology Division, PO PAGANI, ASL SALERNO, Italy
Abstract
Enfortumab vedotin (EV) plus pembrolizumab is an effective first-line treatment for advanced urothelial carcinoma, but clinically significant cutaneous adverse events may require treatment interruption or discontinuation. We report a 74-year-old man with metastatic upper-tract urothelial carcinoma who achieved a complete metabolic and radiologic response after three cycles of EV plus pembrolizumab. After six cycles and before cycle 7, he developed painful plantar lesions that progressed to Common Terminology Criteria for Adverse Events (CTCAE) grade 3 cutaneous toxicity involving the lower limbs, trunk, and oral cavity. Clinicopathological assessment supported erythema multiforme, while a morphologically distinct psoriasiform eruption was identified on the upper limbs. EV plus pembrolizumab was discontinued, and systemic and topical corticosteroid-based treatment produced marked improvement within approximately one month. In view of the grade 3 toxicity and ongoing complete response, treatment was not restarted. This case highlights the uncommon coexistence of two clinically distinct cutaneous patterns during combination therapy and underscores the value of early dermatologic assessment, clinicopathological correlation, and multidisciplinary management when an eruption evolves or displays atypical morphology.
Related
- Skin toxicity and effectiveness of first-line enfortumab vedotin plus pembrolizumab for urothelial carcinoma: a prospective multicenter real-world study in Japan.
- Circulating Tumor DNA Clearance Is Associated with Response and Survival in Metastatic Urothelial Carcinoma Treated with First-Line Enfortumab Vedotin Plus Pembrolizumab
- Skin Toxic Effects and Survival With Enfortumab Vedotin-Pembrolizumab in Advanced Urothelial Carcinoma.
- Management of extravasations of enfortumab vedotin and pembrolizumab: a case report and mini review of the current literature
- Sex-based differences in clinical outcomes of enfortumab vedotin and NECTIN-4 expression in urothelial cancer
BibTeX
@article{trolio2026concurrent,
title = {{Concurrent erythema multiforme and psoriasiform eruption during enfortumab vedotin plus pembrolizumab therapy for advanced urothelial carcinoma}},
author = {Rossella Di Trolio and Giuseppe Di Lorenzo},
journal = {Archive of Clinical Cases},
year = {2026},
month = nov,
doi = {10.22551/2026.53.1304.10352},
url = {https://doi.org/10.22551/2026.53.1304.10352},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Concurrent erythema multiforme and psoriasiform eruption during enfortumab vedotin plus pembrolizumab therapy for advanced urothelial carcinoma
AU - Rossella Di Trolio
AU - Giuseppe Di Lorenzo
PY - 2026
DA - 2026/11/04
JO - Archive of Clinical Cases
DO - 10.22551/2026.53.1304.10352
UR - https://doi.org/10.22551/2026.53.1304.10352
AB - Enfortumab vedotin (EV) plus pembrolizumab is an effective first-line treatment for advanced urothelial carcinoma, but clinically significant cutaneous adverse events may require treatment interruption or discontinuation. We report a 74-year-old man with metastatic upper-tract urothelial carcinoma who achieved a complete metabolic and radiologic response after three cycles of EV plus pembrolizumab. After six cycles and before cycle 7, he developed painful plantar lesions that progressed to Common Terminology Criteria for Adverse Events (CTCAE) grade 3 cutaneous toxicity involving the lower limbs, trunk, and oral cavity. Clinicopathological assessment supported erythema multiforme, while a morphologically distinct psoriasiform eruption was identified on the upper limbs. EV plus pembrolizumab was discontinued, and systemic and topical corticosteroid-based treatment produced marked improvement within approximately one month. In view of the grade 3 toxicity and ongoing complete response, treatment was not restarted. This case highlights the uncommon coexistence of two clinically distinct cutaneous patterns during combination therapy and underscores the value of early dermatologic assessment, clinicopathological correlation, and multidisciplinary management when an eruption evolves or displays atypical morphology.
SN - 2360-6975
ER -