Enfortumab vedotin plus pembrolizumab (EVP) has emerged as frontline treatment for patients with advanced urothelial carcinoma. Consolidative surgery can be offered to select patients with surgically resectable disease following EVP; however, data on their surgical outcomes remain limited. This study reports the outcomes of consolidative surgery for advanced urothelial carcinoma following EVP.
In this retrospective study, we included patients with invasive (≥cT2) urothelial bladder cancer (UBC) or high-risk upper tract urothelial carcinoma (UTUC) who underwent consolidative surgery with curative-intent at our center following EVP between 2022 and 2025. Clinical data, perioperative findings, and oncological outcomes were recorded. The primary endpoint was 30-day postoperative complications and secondary outcomes included pathological complete response (ypT0N0), downstaging (<ypT2N0), disease recurrence, and mortality.
A total of 23 patients (14 with UBC and 9 with UTUC) were included. Median age was 69 years, and 17 patients (74%) were male. Patients received a median of 4 cycles of EVP before surgery. There were no major intraoperative complications, and all surgical margins were negative. Pathologic downstaging and complete pathologic response were observed in 59% and 45% of patients, respectively. After surgery, 64% of patients experienced complications (27% high-grade), with no perioperative mortality. Within a median 14 months postoperative follow-up, 5 patients developed recurrence, of whom 2 died.
These early findings suggest that consolidative surgery following EVP therapy is feasible and may achieve a substantial rate of pathologic response in appropriately selected patients with invasive or locally advanced urothelial carcinoma.
Urologic oncology. 2026 Apr 03 [Epub ahead of print]
Alireza Ghoreifi, Christopher J Hoimes, Sundhar Ramalingam, Hannah D McManus, Deborah R Kaye, Brant A Inman, Michael R Abern, Ankeet M Shah
Department of Urology, Duke University Medical Center, Durham, NC., Department of Medicine, Division of Medical Oncology, Duke Cancer Institute, Duke University, Durham, NC., Division of Urology and Department of Oncology, Verspeeten Family Cancer Center, Western University, London, Ontario, Canada., Department of Urology, Duke University Medical Center, Durham, NC. Electronic address: .