Treatment Outcomes After Progression With Enfortumab Vedotin in Patients With Advanced Urothelial Carcinoma.

Background/aim: Enfortumab vedotin (EV) has been approved for the treatment of advanced urothelial carcinoma (UC) following platinum-based chemotherapy and immune checkpoint inhibitors (ICIs). However, there is no established treatment for patients whose disease progresses while on EV, and the clinical outcomes post-EV treatment are unclear.

Patients and methods: From December 2021 to January 2025, 33 patients with advanced UC received EV monotherapy. After excluding those who discontinued EV due to adverse events or continued treatment without progression, 18 patients were retrospectively analyzed.

Results: The median follow-up was 4.1 months, and 16 patients (88.9%) died at the last follow-up. Ten patients received post-EV treatment (five received chemotherapy and five received ICIs), and eight opted for best supportive care (BSC). The overall survival (OS) was not significantly different between the post-EV and BSC groups (4.6 vs. 3.7 months, p=0.425). No significant differences in the progression-free survival (2.5 vs. 3.2 months, p=0.945) or OS (2.6 vs. 5.1 months, p=0.832) were observed between chemotherapy and ICI treatment in the post-EV treatment group. Patients with lymph node-only metastases had significantly longer OS than those with other metastases (13.5 vs. 3.3 months, p=0.039) in the post-EV treatment group.

Conclusion: Post-EV treatment did not significantly improve the survival compared with BSC in patients with advanced UC. However, patients with lymph node-only metastases may show better outcomes than others. Further research is required to identify effective treatment strategies for this population.