In the EV+pembrolizumab combination, if a patient achieves an excellent response but develops prohibitive EV-related toxicities like neuropathy, a viable strategy is to discontinue EV and maintain the patient on pembrolizumab monotherapy. This can sustain the response while improving quality of life.
Unlike traditional chemotherapy, the EV+pembrolizumab combination is producing a "tail on the curve" in survival data. This indicates a significant minority of patients with metastatic bladder cancer are achieving durable, long-term responses—a phenomenon previously unseen and a paradigm shift for the disease.
For rashes caused by enfortumab vedotin (EV), dupilumab is an emerging steroid-sparing treatment. It can decrease the risk and severity of EV-related rashes, offering an alternative to corticosteroids, which some clinicians worry may blunt the efficacy of concurrent immunotherapy.
When a toxicity like rash occurs with EV+pembrolizumab—which could be caused by either drug—the recommended strategy is to stop both. After the rash improves, reintroduce the drug least suspected of causing it first. If the rash does not recur, it helps confirm the other agent was the culprit.
Although enfortumab vedotin (EV) targets nectin-4, its expression level is a poor predictive biomarker. Even patients with no detectable nectin-4 have achieved complete responses. This makes expression testing clinically unhelpful for patient selection, a counterintuitive finding for a targeted therapy.
A key side effect of the FGFR inhibitor erdafitinib is central serous retinopathy, presenting as blurred vision. Standard of care involves a baseline ophthalmologic exam before starting treatment. If blurred vision occurs, treatment should be held immediately, but the condition is typically reversible and manageable with dose reduction.