Consolidation enfortumab vedotin and pembrolizumab after cisplatin induction in metastatic urothelial cancer: Outcomes of complete response and bladder preservation

Bladder preservation remains a highly desirable therapeutic goal in urothelial carcinoma, particularly when durable survival can be achieved. Radical cystectomy is the standard treatment for muscle-invasive disease; however, it results in irreversible bladder loss and significant morbidity. Among patients with locally advanced or metastatic urothelial carcinoma, recurrence rates after standard therapy remain high. Consolidation therapy with enfortumab vedotin and pembrolizumab following cisplatin-based induction chemotherapy has demonstrated promising efficacy, with substantial complete response rates and improved bladder preservation. This single-center retrospective analysis evaluated the efficacy and safety of enfortumab vedotin plus pembrolizumab as consolidation therapy in 11 patients with metastatic urothelial carcinoma who completed cisplatin-based induction chemotherapy. More than 90% of patients achieved a radiographic or clinical complete response, and several maintained prolonged treatment-free remission. Treatment-related adverse events, including dermatologic toxicity, reversible peripheral neuropathy, and hyperglycemia, were observed but were predominantly manageable, allowing treatment continuation in most cases. Notably, the regimen demonstrated clinical activity in cisplatin-intolerant patients and in those who did not achieve an initial complete response after cisplatin therapy. Compared with conventional cisplatin-based therapy alone, consolidation with enfortumab vedotin plus pembrolizumab was associated with favorable tolerability, durable responses, and a high rate of bladder preservation. These findings support further investigation of enfortumab vedotin and pembrolizumab as a potential bladder-sparing strategy in advanced urothelial carcinoma.