Dr Petrylak on Treatment With Enfortumab Vedotin/Pembrolizumab in Urothelial Carcinoma

Daniel Petrylak, MD, professor, medicine, Medical Oncology and Urology, chief, Genitourinary Oncology, Yale School of Medicine, discusses treatment with enfortumab vedotin-ejfv (Padcev) plus pembrolizumab (Keytruda) in patients with urothelial carcinoma in the community setting.

For community oncologists who may not routinely encounter patients with advanced bladder cancer, navigating the dosing of enfortumab vedotin requires a nuanced approach akin to pacing oneself in a marathon, Petrylak begins. Just as in a marathon, where conserving energy is crucial for enduring the entire race, with enfortumab vedotin, it's vital to avoid expending all treatment potency upfront, he states. Rather, it's advisable to maintain some reserve, especially as patients progress further in their treatment, Petrylak notes.

In cases where patients report neuropathy, it's prudent to consider dose reduction or temporary cessation of enfortumab vedotin administration, Petrylak expands. This proactive measure is essential because once neuropathy sets in, managing this adverse effect becomes challenging and could compromise the treatment's overall efficacy, he explains. The goal of treatment with enfortumab vedotin is to ensure prolonged administration of the drug, allowing for potentially more cumulative doses over time, which ultimately contributes to treatment success, according to Petrylak. Petrylak recommends oncologists adopt a comprehensive approach to care during patient consultations, using their expertise or that of nurse practitioners to closely monitor signs of neuropathy. This involves actively inquiring about specific symptoms, such as difficulties with fine motor tasks like buttoning a shirt, writing, or tying shoes, as well as sensations of numbness in the extremities, he adds. A positive response to these inquiries should prompt heightened vigilance regarding neuropathy progression, Petrylak says.

When neuropathy is detected or worsens, it's appropriate to consider temporary enfortumab vedotin dose holds or reductions, Petrylak continues. In his clinical experience, temporary dose holds have not adversely affected disease stability, underscoring the importance of judiciously managing treatment-related toxicities and simultaneously maintaining therapeutic efficacy, he says. This treatment approach underscores the need for oncologists to remain vigilant and adaptable in tailoring treatment strategies to individual patient needs, ultimately optimizing outcomes in the management of advanced bladder cancer, Petrylak concludes.