Treatment Outcomes after Progression on Enfortumab Vedotin in Patients with Advanced Urothelial Carcinoma - Expert Commentary
A recent retrospective study by Furubayashi et al. evaluated clinical outcomes of post-EV treatments compared with best supportive care (BSC) in patients with advanced UC. From December 2021 to January 2025, 33 patients with advanced UC received EV monotherapy, with 18 patients included in the final analysis after excluding those who discontinued due to adverse events or continued without progression. The median follow-up was 4.1 months, with 16 patients (88.9%) deceased at the time of the last follow-up. Ten patients received post-EV treatment (five received chemotherapy and five received ICIs), while eight opted for BSC. Overall survival (OS) was not significantly different between the post-EV treatment and BSC groups (4.6 vs. 3.7 months, p=0.425). Among patients receiving post-EV treatment, no significant differences in progression-free survival (2.5 vs. 3.2 months, p=0.945) or OS (2.6 vs. 5.1 months, p=0.832) were observed between chemotherapy and ICI. Notably, patients with lymph node-only metastases demonstrated significantly longer OS than those with other metastatic sites (13.5 vs. 3.3 months, p=0.039) in the post-EV treatment group.
This study highlights the urgent need for effective post-EV treatments. Further research is needed to identify the optimal sequence of treatments. This is particularly important as EV+pembro is now the first line of therapy for patients with metastatic UC and is currently being tested for localized disease.
Written by: Bishoy M. Faltas, MD, Chief Research Officer, Englander Institute for Precision Medicine, Gellert Family - John P. Leonard, MD, Research Scholar, Associate Professor of Medicine, Cell and Developmental Biology, Weill Cornell Medicine, New York- Presbyterian Hospital, NY
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