Efficacy of enfortumab vedotin in advanced urothelial cancer: Analysis from the Urothelial Cancer Network to Investigate Therapeutic Experiences (UNITE) study
Authors: Koshkin Vadim S. , Henderson Nicholas , James Marihella , Natesan Divya , Freeman Dory , Nizam Amanda , Su Christopher T. , Khaki Ali Raza , Osterman Chelsea K. , Glover Michael J. , Chiang Ryan , Makrakis Dimitrios , Talukder Rafee , Lemke Emily , Olsen T. Anders , Jain Jayanshu , Jang Albert , Ali Alicia , Jindal Tanya , Chou Jonathan , Friedlander Terence W. , Hoimes Christopher , Basu Arnab , Zakharia Yousef , Barata Pedro C. , Bilen Mehmet A. , Emamekhoo Hamid , Davis Nancy B. , Shah Sumit A. , Milowsky Matthew I. , Gupta Shilpa , Campbell Matthew T. , Grivas Petros , Sonpavde Guru P. , Kilari Deepak , Alva Ajjai S. 
Published: December 2021

Background

Enfortumab vedotin (EV) is a novel antibody‐drug conjugate approved for advanced urothelial cancer (aUC) refractory to prior therapy. In the Urothelial Cancer Network to Investigate Therapeutic Experiences (UNITE) study, the authors looked at the experience with EV in patient subsets of interest for which activity had not been well defined in clinical trials.

Methods

UNITE was a retrospective study of patients with aUC treated with recently approved agents. This initial analysis focused on patients treated with EV. Patient data were abstracted from chart reviews by investigators at each site. The observed response rate (ORR) was investigator‐assessed for patients with at least 1 post‐baseline scan or clear evidence of clinical progression. ORRs were compared across subsets of interest for patients treated with EV monotherapy.

Results

The initial UNITE analysis included 304 patients from 16 institutions; 260 of these patients were treated with EV monotherapy and included in the analyses. In the monotherapy cohort, the ORR was 52%, and it was >40% in all reported subsets of interest, including patients with comorbidities previously excluded from clinical trials (baseline renal impairment, diabetes, and neuropathy) and patients with fibroblast growth factor receptor 3 (FGFR3) alterations. Progression‐free survival and overall survival were 6.8 and 14.4 months, respectively. Patients with a pure urothelial histology had a higher ORR than patients with a variant histology component (58% vs 42%; P = .06).

Conclusions

In a large retrospective cohort, responses to EV monotherapy were consistent with data previously reported in clinical trials and were also observed in various patient subsets, including patients with variant histology, patients with FGFR3 alterations, and patients previously excluded from clinical trials with an estimated glomerular filtration rate < 30 mL/min and significant comorbidities.

Lay Summary

Enfortumab vedotin, approved by the Food and Drug Administration in 2019, is an important new drug for the treatment of patients with advanced bladder cancer.

This study looks at the effectiveness of enfortumab vedotin as it has been used at multiple centers since approval, and focuses on important patient populations previously excluded from clinical trials. These populations include patients with decreased kidney function, diabetes, and important mutations.

Enfortumab vedotin is effective for treating these patients. Previously reported clinical trial data have been replicated in this real‐world setting, and support the use of this drug in broader patient populations.