Advanced urothelial carcinoma treated with enfortumab vedotin and pembrolizumab: a path to cure?
The combination of enfortumab vedotin and pembrolizumab (EVP) has recently revolutionized care for patients with previously untreated locally advanced and metastatic urothelial carcinoma. However, predictive biomarkers of response, the optimal duration of EVP for patients who respond well to therapy, and the role of circulating tumor DNA to monitor treatment response have not yet been fully elucidated. In this molecular tumor board, we summarize 6 patients from 4 different academic institutions with unresectable or oligometastatic urothelial carcinoma who achieved long-term remission on surveillance after a short duration of EVP treatment that resulted in complete response on follow-up imaging followed by consolidative radical cystectomy. We discuss potential predictive biomarkers for patients with exceptional response to EVP. These findings highlight the need to determine an optimal duration of EVP to maximize efficacy while minimizing adverse events. We aim to further define and explore the value of local therapy with consolidative cystectomy in the setting of unresectable, locally advanced, oligometastatic disease, or those with metastatic disease who achieve complete response of disease outside of the bladder. Identifying this subset of patients who may be candidates for this type of multidisciplinary management may result in durable treatment-free remission.
Authors
- Nikita Tripathi (ORCID: https://orcid.org/0000-0003-3499-3613)
- Matthew T. Campbell (ORCID: https://orcid.org/0000-0003-1915-4491)
- Albert Jang (ORCID: https://orcid.org/0000-0002-0461-6174)
- Sree M Lanka (ORCID: https://orcid.org/0000-0002-9133-0667)
- Vadim S. Koshkin (ORCID: https://orcid.org/0000-0003-2277-8668)
- Prateek Jain (ORCID: https://orcid.org/0000-0002-8191-9785)
- Adam Calaway (ORCID: https://orcid.org/0000-0001-6716-3806)
- Jonathan Evan Shoag (ORCID: https://orcid.org/0000-0002-3119-9986)
- Pedro Coelho Barata (ORCID: https://orcid.org/0000-0002-8890-2951)
- Jason Robert Brown (ORCID: https://orcid.org/0000-0001-6225-7555)
- Prateek Mendiratta
- Randy Vince (ORCID: https://orcid.org/0000-0002-7779-473X)
- Santosh Rao
- Jorge Alberto Garcia (ORCID: https://orcid.org/0009-0001-6897-4237)
- Hamsa L.S. Kumar (ORCID: https://orcid.org/0000-0003-1971-1737)
- Parminder Singh (ORCID: https://orcid.org/0000-0002-8548-6948)
Institutions
- Tulane University (US)
- The University of Texas MD Anderson Cancer Center (US)
- University Hospitals of Cleveland (US)
- Mayo Clinic in Arizona (US)
- Mayo Clinic Hospital (US)
- University School (US)
- UCSF Helen Diller Family Comprehensive Cancer Center (US)
- Case Western Reserve University (US)
Publication Details
- Journal
- The Oncologist
- Published
- 2025-08-16
- DOI
- https://doi.org/10.1093/oncolo/oyaf259
- Citations
- 1
- Primary Topic
- Bladder and Urothelial Cancer Treatments
- Type
- article
- Field-Weighted Citation Impact
- 2.01
Funders
- Prostate Cancer Foundation
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- AstraZeneca
- Gilead Sciences
- Endocyte
- Exelixis
- Hope Foundation
- Jounce Therapeutics
- Cardinal Health
- Seagen
- Eisai
- Astellas Pharma
- Ipsen
- Aptitude Health
- Genentech
- EMD Serono
- Loxo Oncology
- Janssen Research and Development