Neoadjuvant Disitamab Vedotin and Toripalimab in Recurrent High- Grade Muscle-Invasive Bladder Cancer: A Case Report

Background Currently, the standard treatment for muscle-invasive urothelial bladder cancer (MIBC) involves cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC). However, the high frequency of adverse reactions has led to a relatively low clinical adoption rate of this regimen. Therefore, there is still an urgent need to discover an effective and less toxic form of neoadjuvant therapy. Case presentation: We present a case of a 71-year-old patient with recurrent bladder cancer. Imaging revealed muscle-invasive bladder cancer with multiple lymph node metastases in the pelvic cavity. The right ureteral orifice was infiltrated, leading to severe hydronephrosis of the right kidney. To correct coronary artery stenosis, the patient underwent stent placement, which precluded radical cystectomy during the perioperative period. Based on the patient's medical history, tumor characteristics, and immunohistochemical findings, neoadjuvant therapy with toripalimab combined with disitamab vedotin was initiated. Preoperative imaging demonstrated near-complete resolution of the primary tumor and metastatic lymph nodes, while postoperative pathological examination confirmed pathological complete response. Conclusions Disitamab vedotin combined with Toripalimab demonstrated outstanding efficacy and safety in the preoperative neoadjuvant treatment of HER2-positive MIBC patients. Antibody-drug conjugates combined with novel immune checkpoint inhibitors are a promising preoperative neoadjuvant therapy that deserves further exploration.