Dr Rosenberg on Toxicity Management With Enfortumab Vedotin Plus Pembrolizumab in Urothelial Cancer

Jonathan E. Rosenberg, MD, chief, Genitourinary Oncology Service, Division of Solid Tumor Oncology; Enno W. Ercklentz, Jr. Chair, Memorial Sloan Kettering Cancer Center, discusses administration and toxicity considerations to monitor when considering treatment with enfortumab vedotin-ejfv (Padcev) plus pembrolizumab (Keytruda) in community practice to patients with urothelial cancer.

The combination of enfortumab vedotin and pembrolizumab is administered on a 3-week schedule, which differs from the 4-week schedule used to administer enfortumab vedotin monotherapy, Rosenberg begins. This difference in scheduling is a practical consideration for patient monitoring, he says. Patients will need more frequent monitoring earlier in the treatment course, particularly within the first 1 to 2 months, when severe skin toxicity associated with enfortumab vedotin can emerge. Although visits every day 8 may not be necessary after the initial cycles, close monitoring in the early stages of treatment is crucial to promptly identify and manage potential life-threatening toxicities, Rosenberg explains.

As treatment progresses, peripheral neuropathy often becomes a more prominent issue, especially among patients who are responding well and remain on treatment for an extended period of time, Rosenberg continues. Sensory and motor neuropathy can impact patients' quality of life and, if not managed effectively, may become incapacitating, he adds. Dose reductions can help mitigate neuropathy and improve treatment tolerability for affected patients, he says.

Early recognition and intervention are key to managing skin toxicities associated with enfortumab vedotin and pembrolizumab, Rosenberg emphasizes. Collaborating with a dermatologist can be beneficial in implementing strategies such as topical steroids to control skin reactions. Most patients tolerate skin toxicities well, as long as they are not severe or blistering, he adds. With appropriate management, including dose adjustments and supportive care, treatment can often be continued effectively, even if temporary breaks are needed to address toxicities, Rosenberg states.

Overall, proactive monitoring, timely interventions, and collaborative management approaches are essential for optimizing the safety and tolerability of combination therapies like enfortumab vedotin and pembrolizumab in patients with advanced cancer, Rosenberg concludes.