A key eligibility criterion for the landmark EV-302 trial was glycemic control. Patients with an A1C above 8 were excluded due to hyperglycemia and diabetic ketoacidosis (DKA) risk from the enfortumab vedotin component. This has critical implications for patient selection and monitoring.
While cisplatin is standard in most urothelial cancer settings, carboplatin is an acceptable adjuvant option specifically after nephroureterectomy for upper tract disease. This is a logical adaptation, as patients have lost a kidney, increasing their risk of renal dysfunction with the more nephrotoxic cisplatin.
The EV Pembro combination is the new first-line standard for metastatic bladder cancer, replacing platinum chemotherapy. This shift leaves clinicians without clear, trial-backed evidence for second-line treatment, as previous trials for other agents were all designed for post-platinum progression.