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Case report: Enfortumab vedotin induced refractory DKA and multi organ failure - a rare fatal adverse event

Astha Koolwal Kapoor1, Carleton S Ellis2,3, Deepali Pandey2

  • 1Department of Internal Medicine, Vassar Brothers Medical Center Nuvance Health, Poughkeepsie, NY, United States.

Frontiers in Oncology
|March 1, 2024
PubMed

Insights

Enfortumab vedotin (EV) can cause severe diabetic ketoacidosis (DKA) in urothelial cancer patients. This case report highlights refractory DKA and reviews similar literature for better management strategies.

Area of Science:

  • Oncology
  • Pharmacology

Background:

  • Locally advanced or metastatic Urothelial Cancer (UC) has limited treatment options.
  • Enfortumab vedotin (EV) is an approved therapy for UC, offering a new treatment avenue.
  • Despite efficacy, EV can cause severe adverse events.

Observation:

  • A case of UC patient treated with EV developed refractory diabetic ketoacidosis (DKA).
  • DKA was unresponsive to high-dose insulin and required continuous renal replacement therapy.
  • The patient later experienced skin rash, liver, and respiratory failure.

Findings:

  • EV-induced refractory DKA is a rare but serious complication.
  • Review of literature shows similar patient profiles and adverse event timelines.
  • Management strategies for EV-induced DKA and complications are explored.

Implications:

  • Clinicians should be vigilant for DKA in patients receiving EV.
  • Early recognition and management of DKA are crucial.
  • Further research into EV's metabolic side effects is warranted.
Keywords:
CRRTdiabetes ketoacidosisenfortumab vedotininsulinliver failuremaculopapular rash

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