Alexandra Drakaki, MD, on managing peripheral neuropathy on enfortumab vedotin

In this video, Alexandra Drakaki, MD, PhD, discusses how early recognition and proactive management of peripheral neuropathy are essential to maintaining patients with locally advanced or metastatic urothelial carcinoma on enfortumab vedotin-ejfv (Padcev) while minimizing long-term toxicity. Drakaki is an associate professor of hematology/oncology at the University of California, Los Angeles.

Drakaki emphasized that clinicians should begin screening for peripheral neuropathy early in the treatment course, before patients meet formal grading criteria. Neuropathy can present with both sensory and motor symptoms, with patients reporting numbness and tingling as initial signs. However, she noted that careful clinical observation, such as assessing gait and motor function, can help identify early motor involvement, which may warrant more urgent intervention. These subtle findings highlight the importance of routine, proactive assessment at each visit rather than relying solely on patient-reported symptoms.

Drakaki also underscored the challenge of underreporting, as patients may fear that disclosing symptoms will lead to treatment interruption. To address this, clinicians should frame counseling at treatment initiation around reassurance and partnership, emphasizing that early reporting enables timely intervention and may prevent permanent neuropathy. By educating patients that dose modifications and supportive strategies can allow them to remain on therapy longer, providers can encourage more transparent communication and improve overall management.

In the absence of formal consensus guidelines, Drakaki pointed to emerging recommendations from a multidisciplinary Delphi panel, which aim to provide structured guidance on evaluation and dose modification.¹ These recommendations stress individualized decision-making based on neuropathy severity and treatment response, balancing efficacy with toxicity risk. According to the panel, multidisciplinary approaches, including pharmacologic management and rehabilitative support, may help mitigate symptoms and preserve quality of life.

REFERENCE

1. Drakaki A, Kurian M, Mar N, et al. Consensus guidance on early identification and management of peripheral neuropathy in patients with UC receiving enfortumab vedotin: A Delphi study. Presented at: 2026 American Society of Clinical Oncology Genitourinary Cancers Symposium. February 26-28, 2026. San Francisco, California. Abstract 661. https://www.asco.org/abstracts-presentations/256954/abstract