An overview of the toxicity profile of enfortumab vedotin and pembrolizumab in patients being treated for urothelial carcinoma.
Case 2: A 76-Year Old Man with Locally Advanced, Resectable Urothelial Carcinoma
Initial Clinical Presentation:
Initial Clinical Workup:
Treatment and Disease Progression:
This is a synopsis of a Case-Based Peer Perspectives series featuring Scott T. Tagawa, MD, MS, FACP, FASCO, of Weill Cornell Medicine.
Scott T. Tagawa, MD, MS, FACP, FASCO discussed key adverse events and toxicity management with enfortumab vedotin (EV), both as monotherapy and in combination with pembrolizumab.
He first noted that hyperglycemia is a rare but potentially serious toxicity requiring blood glucose monitoring at baseline and during treatment. More common adverse events are skin toxicity and peripheral neuropathy. Skin toxicity manifesting as rash occurs in about half of patients, sometimes shortly after infusion as highlighted in the case presentation. While most rashes resolve with topical therapies, severe reactions like Stevens-Johnson syndrome are possible. Dose delays or reductions may be employed for severe or persistent rash.
Peripheral neuropathy is also common, affecting around 50% of patients with extended EV exposure. Onset is typically later in treatment rather than with first dose. Sensory, motor or mixed neuropathies occur and may be exacerbated by other neurotoxic agents like platinums. Dose reductions or alternate week dosing can allow most patients to continue EV therapy. For painful neuropathies, additional symptomatic management is available.
Dr. Tagawa commented that for some patients who must discontinue EV early for toxicity such as neuropathy, rechallenge may be possible later on. However, other new agents like antibody-drug conjugates are now available, allowing EV discontinuation without loss of subsequent treatment options.
In summary, diligent toxicity monitoring and dose adjustments enable continuity of what is often an effective therapy for advanced urothelial carcinoma. Research continues to optimize therapy duration and combine or sequence EV with other emerging treatments to maximize clinical benefit.
*Video synopsis is AI-generated and reviewed by Urology Times editorial staff.