Enfortumab Vedotin With or Without Pembrolizumab Delivers Promising Responses for Upper Tract Urothelial Cancer

While cisplatin chemotherapy is the first-line treatment for perioperative management of invasive urothelial cancer, patients with upper tract urothelial cancer are ineligible for cisplatin for a variety of reasons, such as comorbidities or surgery-related renal function. However, enfortumab vedotin with or without pembrolizumab has been identified as a regimen of interest for these patients with upper tract urothelial cancer, explained Evangelia Vlachou, MD, a postdoctoral research fellow at Johns Hopkins Medicine.

“These patients are often capped or excluded from urothelial cancer trials, and particularly in the perioperative setting,” she added. "So, we felt that an important question to ask is whether enfortumab and enfortumab with pembrolizumab, which has revolutionized the management of the advanced setting, can also be used in the perioperative setting, and particularly in patients with upper tract [urothelial cancer].”

An abstract presented at ASCO GU presented the findings of a retrospective analysis of the radiographic response of patients with locally advanced and metastatic primary upper tract urothelial cancer who received enfortumab vedotin or enfortumab vedotin plus pembrolizumab.

The study included 22 patients with upper tract urothelial cancer who had been treated with enfortumab vedotin with or without pembrolizumab. Most (81.8%) of patients had visceral metastases at baseline. The objective response rate was 36.4% and the disease control rate, calculated as complete response plus partial response plus stable disease, was 72.3%.

Vlachou added that there is a need to follow up this research with a study that includes a larger patient population with a prospective design.

More research into the use of enfortumab vedotin and pembrolizumab in previously untreated locally advanced or metastatic urothelial carcinoma will be presented later in the meeting. Thomas Powles, MD, PhD, is presenting an updated analysis from the phase 3 global trial EV-302 with 886 patients randomized to receive either the combination or chemotherapy.