Dr. Gupta on toxicity management with enfortumab vedotin/pembrolizumab in urothelial carcinoma

Shilpa Gupta, MD, director of genitourinary medical oncology at Taussig Cancer Institute and co-leader of the Genitourinary Oncology Program at Cleveland Clinic, discusses toxicity management with the combination of pembrolizumab (Keytruda) and erdafitinib (Balversa) in patients with urothelial carcinoma. At the 2023 ASCO Annual Meeting, Gupta shared 4-year follow-up data from the EV-103 trial (abstract 4505), which continued to show rapid and durable response and promising survival trends with the combination in the front-line setting for cisplatin-ineligible patients with locally advanced or metastatic urothelial carcinoma. Gupta says if the ongoing EV-302 phase 3 trial (NCT04223856) firmly establishes pembrolizumab/erdafitinib as the new standard in this setting, successful management of adverse events will be critical to ensure patients can remain on this regimen.

Transcript

The key here is that with the use of the enfortumab vedotin/pembrolizumab combination, especially with the use of enfortumab vedotin, there can be toxicities like peripheral neuropathy, which can become disabling and it takes a long time to resolve. However, if dose modifications and dose discontinuations are properly done, then one can control that. I think the understanding of this new regimen and the toxicities are very important because the rash and the peripheral neuropathy can be challenging. So it's very important to really talk to the patients and understand any toxicities because it's well managed if it's caught early. So I think moving forward, if this becomes the standard, there's a lot of learning that needs to happen in terms of management of side effects.

Transcript has been edited for clarity.