一名 71 岁男性因劳力性呼吸困难就诊。胸部X光检查显示多个肺部结节，增强计算机断层扫描显示可疑右肾盆腔癌的发现。经皮肺肿瘤活检显示组织学诊断为尿路上皮癌，诊断为右肾盂癌cT3N2M1。使用吉西他滨和顺铂进行初次化疗期间显示出良好的反应，但在四个周期后导致肿瘤进展。该患者转而接受二线治疗，派姆单抗，导致肿瘤快速生长。怀疑病情过度进展，患者立即转为三线治疗，即 enfortumab vedotin。肿瘤明显缩小。三个治疗周期后，观察到肠炎不良事件。肠粘膜活检得出了迟发性免疫相关不良事件的组织病理学诊断；因此，可以继续使用 enfortumab vedotin。

A 71-year-old man presented with exertional dyspnea. Chest radiography revealed multiple pulmonary nodules, and contrast-enhanced computed tomography showed findings suspicious of right renal pelvic cancer. Percutaneous lung tumor biopsy revealed a histological diagnosis of urothelial carcinoma, and right renal pelvic cancer cT3N2M1 was diagnosed. Favorable response was shown during primary chemotherapy with gemcitabine and cisplatin but resulted in tumor progression after four cycles. The patient was switched to a second-line treatment, pembrolizumab, which resulted in rapid tumor growth. Hyper-progression was suspected, and the patient was promptly switched to a third-line treatment, enfortumab vedotin. The tumor shrank significantly. After three treatment cycles, an adverse event of enteritis was observed. A biopsy of the intestinal mucosa led to a histopathologic diagnosis of late-onset immune-related adverse event; therefore, enfortumab vedotin could be continued.