Perioperative Enfortumab Vedotin and Pembrolizumab in Bladder Cancer

To the Editor: Vulsteke et al. (April 2 issue) 1 report a substantial 2-year event-free survival with perioperative enfortumab vedotin and pembrolizumab in cisplatin-ineligible patients with muscle-invasive bladder cancer, as well as a remarkably high percentage of those who had a pathological complete response. Of note, the magnitude of pathological complete response suggests that many patients may have minimal residual disease after neoadjuvant therapy alone. Given the 100% incidence of adverse events and the high incidence of toxic effects of grade 3 or higher, the uniform addition of an adjuvant phase may not be justified. Circulating tumor DNA (ctDNA) provides a . . .