Systematic review and meta-analysis of enfortumab vedotin with or without pembrolizumab for metastatic urothelial carcinoma

Metastatic urothelial carcinoma (mUC) presents a therapeutic challenge with poor outcome. Researchers at National Cancer Center Hospital East (Chiba, Japan) carried out a systematic review and meta-analysis of enfortumab vedotin (EV) with or without pembrolizumab for mUC. The authors identified 11 studies involving 2128 patients. Of these patients, 563 (26.5%) received EV plus pembrolizumab, 814 (38.3%) received EV without pembrolizumab, and 751 (35.3%) received chemotherapy. EV plus pembrolizumab was associated with a pooled disease control rate (DCR) of 86%, a pooled objective response rate (ORR) of 68%, and a one-year survival rate of 79%. EV monotherapy had a pooled DCR of 73%, ORR of 43%, and one-year survival rate of 52%. Network meta-analysis revealed that EV plus pembrolizumab outperformed chemotherapy in ORR (OR 3.47; p=0.004) and one-year survival (OR 2.32; p<0.001). EV plus pembrolizumab showed high response rates in first-line settings, while EV monotherapy was associated with clinical benefit in later lines of therapy. The authors conclude that EV, especially combined with pembrolizumab, offers promising beneficial outcomes in mUC treatment.