Rationale:
Enfortumab vedotin (EV) is an antibody-drug conjugate, approved for the treatment of locally advanced or metastatic urothelial carcinoma1.
This case report describes an extravasation event and highlights the clinical presentation, management, and outcomes. Implications for clinical practice based on current guidelines and literature are also discussed.
Background:
65-year-old male was initially diagnosed with muscle invasive urothelial carcinoma in March 2024. On restaging, CT scan was found to have progression of disease and commenced first dose of EV in February 2025. On cycle 2 day 8 of EV, the patient experienced an extravasation event at the right distal forearm peripheral intravenous catheter site. Symptoms of pain and swelling at the cannula site occurred during the saline flush.
Management and Outcome:
Immediate management followed eviQ guidelines on extravasation. On Day 4, the patient presented with right arm erythema, swelling, blistering and paraesthesia to the area.
The patient was admitted to the hospital for close observation. Pharmacist played a crucial role in contributing to the management of extravasation which involved pain management and follow-up care.
Impact on practice:
Currently in Australia, EV is classified as an irritant, causing local inflammation and irritation without severe tissue damage. International case reports suggest that extravasation of EV causes necrosis of surrounding tissue, labelling it as a vesicant2,3,4.
Discussion:
This case, along with supporting literature, emphasizes the importance of early recognition, appropriate intervention, and adherence to established guidelines to optimize patient outcomes.
In Australia, the eviQ guidelines set the standard for managing extravasation events in oncology. According to eviQ, EV is classified as an irritant, with recommendations for the application of cold compresses and no indication for an antidote5. However, a comparison with the literature and this specific case suggests that EV should be re-classified as a vesicant or as an irritant with vesicant properties.