Paradigm Shift in Non–Cisplatin-Eligible Muscle-Invasive Bladder Cancer

Clinical Takeaway

: Perioperative enfortumab vedotin plus pembrolizumab improved event-free and overall survival.

Context

For patients with muscle-invasive bladder cancer (MIBC) who aren’t candidates for cisplatin-based combination chemotherapy (typically because of renal insufficiency or poor performance status), management options include radical cystectomy or radiotherapy. These patients tend to have poorer disease control than patients eligible for cisplatin.

Enfortumab vedotin, a nectin-4–directed antibody–drug conjugate, plus pembrolizumab (EVP) is now the standard of care for patients with metastatic urothelial cancer, irrespective of renal function, based on the phase 3 EV-302/KEYNOTE-A39 study.

Now, investigators report the results of the international, randomized, phase 3 KEYNOTE-905/EV-303 trial. Participants had MIBC and were either cisplatin-…

Reviewing Author

Robert Dreicer, M.D., M.S., M.A.C.P., F.A.S.C.O.

Disclosures

Consultant/Advisory BoardAstellas; Merck; Pfizer; LNC Pharma, UroGen Pharma

Grant/Research SupportMacroGenics; Bristol Myers Squib; Exelixis; Regeneron

Editorial BoardsCurrent Urology Reports