Chemotherapy sequential disitamab vedotin in combination with tislelizumab as systemic therapy of upper tract urothelial carcinoma with cutaneous metastasis: A case report and literature review.

[RATIONALE] To investigate the clinical features, management strategies, and prognosis of the rare condition of upper tract urothelial carcinoma (UTUC) with skin metastasis, with emphasis on the efficacy and safety of disitamab vedotin combined with tislelizumab in systemic therapy, we performed a literature search and selection. We searched PubMed, Embase, and Web of Science for English-language publications from January 1, 1990, through December 10, 2024 (last search December 10, 2024). Predefined terms combined "upper tract urothelial carcinoma" or "UTUC" with "skin," "cutaneous," "abdominal wall," or "port-site," and with "metastasis," "implantation," or "seeding." Inclusion criteria were human case reports or small series with histologically confirmed UTUC and cutaneous involvement. We excluded non-UTUC primaries, noncutaneous metastases, pure reviews without primary cases, duplicate reports, and articles lacking extractable case-level clinical or pathologic data. Two reviewers independently screened records and extracted data (patient and tumor features, site and timing of cutaneous involvement, other metastases, postdiagnosis treatment, and outcomes), resolving discrepancies by consensus. Owing to rarity and heterogeneity, we performed a qualitative descriptive synthesis without meta-analysis.

[PATIENT CONCERNS] A patient developed a progressively enlarging cutaneous mass on the abdominal wall at a prior laparoscopic port site following renal cyst surgery.

[DIAGNOSES] Biopsy confirmed metastatic poorly differentiated urothelial carcinoma. On April 27, 2023, the patient underwent robot-assisted radical nephrectomy with abdominal wall tumor resection and latissimus dorsi myocutaneous flap transfer. Postoperative pathology revealed high-grade urothelial carcinoma with human epidermal growth factor receptor 2 (+++) expression.

[INTERVENTIONS] Gemcitabine/cisplatin was administered initially; however, due to intolerance to cisplatin-based chemotherapy, sequential disitamab vedotin (120 mg every 3 weeks) plus tislelizumab (200 mg every 3 weeks) was initiated on November 23, 2023.

[OUTCOMES] At 24-month postoperative follow-up, there was no evidence of local recurrence at the surgical site.

[LESSONS] Cutaneous metastasis in UTUC is rare and portends a poor prognosis. Radical surgery combined with systemic therapy remains the cornerstone of care. In this case, disitamab vedotin plus tislelizumab, used as a postoperative sequential systemic regimen, demonstrated favorable safety and achieved a 24-month recurrence-free interval after discontinuation of gemcitabine/cisplatin due to intolerance, with manageable adverse effects. This combination may represent a potential treatment option for metastatic UTUC, although its efficacy requires validation in larger cohorts.