Outcomes of patients with metastatic urothelial carcinoma following prior enfortumab vedotin-pembrolizumab: A real-world analysis

Enfortumab vedotin plus pembrolizumab (EV-P) has emerged as the preferred first-line (1L) therapy for metastatic urothelial carcinoma (mUC). However, outcomes with systemic therapy following prior exposure to EV-P are unclear. We studied outcomes of pts with mUC following prior EV-P. 

A retrospective, observational real-world study aimed to describe patterns of systemic therapy and outcomes of pts following prior EV-P for mUC. The ConcertAI Patient360ä Bladder database was selected, a deeply curated real-world oncology dataset from institutions in the USA linking EHR, claims, genomics, and death date. Statistical analysis was conducted using R. Descriptive statistics are reported. Kaplan-Meier survival analysis was used to characterize time-to-event outcomes

A total of 248 patients were available for analysis: 172 (69.4%) were post EV-P as 1L therapy, 44 (17.7%) were in the 2L setting, and 32 (12.9%) were in the 3L or later setting. 29 pts (11.7%) harbored FGFR3 genomic alterations (42 [16.9%] negative, remaining unknown). The median OS of the entire population following EV-P was 15.5 months (mo). 59 (23.8%) patients went on to receive subsequent treatment after EV-P. 37 (14.9%), 22 (8.9%) and 189 (76.2%) received subsequent 1, ≥2 or no lines of subsequent therapy, respectively. When examining all regimens given in any line following EV-P, regimens containing platinum chemotherapy (31 [52.5%]), sacituzumab govitecan (17 [28.8%]) and erdafitinib (12 [20.3%]) were most common. Outcomes of pts who received no subsequent therapy vs. some subsequent therapy showed median survival of 13.7 (95% CI: 10.2-17.1) vs. 19.0 (95% CI: 15.1-22.3) mo.

This is the first real-world dataset to examine treatment patterns and outcomes following EV-P in pts with mUC. Our data reveal that a minority of pts receive therapy following EV-P for mUC, yet median OS was 15.5 mo overall and 19.0 mo for those who received some treatment. Further investigation of the potentially favorable long-term impact of EV-P even after discontinuation, and optimal sequencing of therapy following EV-P is warranted.