Case report: Near-complete pathological response with Enfortumab vedotin plus toripalimab as neoadjuvant therapy for HER2-negative muscular-invasive bladder cancer

Purpose: To report the efficacy and safety of enfortumab vedotin combined with toripalimab as neoadjuvant therapy in an elderly patient with Muscular-invasive bladder cancer (MIBC) who sought bladder preservation. Methods: An 83-year-old male presented with painless gross hematuria. Imaging revealed a 44 mm×39 mm×60 mm bladder mass, and biopsy confirmed high-grade invasive papillary urothelial carcinoma (T2NxM0). After informed consent, the patient received three cycles of neoadjuvant therapy combining enfortumab vedotin (60 mg on days 1 and 8) with toripalimab (240 mg on days 1 and 8) in 21-day cycles. Results: Treatment-related adverse events included hyperglycemia and rash, both managed conservatively without treatment interruption. Post-treatment MRI demonstrated marked tumor reduction, showing only bladder wall thickening. Subsequent transurethral resection of bladder tumor (TURBT) revealed chronic mucosal inflammation with histiocyte aggregation and focal cystic cystitis, with no residual carcinoma identified, achieving near-complete pathological response. Conclusion: This case demonstrates that neoadjuvant enfortumab vedotin combined with toripalimab can achieve near-complete pathological response and successful bladder preservation in carefully selected elderly patients with MIBC, providing valuable real-world evidence for this perioperative treatment approach.