Metastatic Urothelial Carcinoma After Platinum Chemotherapy Failure: What to Do When Both Enfortumab Vedotin and Checkpoint Inhibitors Are Contraindicated
This protocol applies to patients with metastatic or unresectable urothelial carcinoma (ECOG PS 0–2) who have progressed on first-line platinum-based chemotherapy and who cannot receive enfortumab vedotin or checkpoint inhibitor therapy at this stage.
Metastatic or unresectable urothelial carcinoma • ECOG performance status 0–2 • eGFR ≥ 30 mL/min • Contraindications to enfortumab vedotin • Contraindications to checkpoint inhibitor therapy
At first line, these patients were not eligible for enfortumab vedotin or checkpoint inhibitor therapy and received platinum-containing combination chemotherapy (cisplatin or carboplatin plus gemcitabine) as initial systemic treatment.
This protocol is indicated when that platinum-based regimen failed to achieve an objective response.
The next step involves systemic agents — the choice among available options depends in part on tumour molecular characteristics and prior treatment history. The complete selection criteria, agent hierarchy, and eligibility details are in the full protocol.
References
If contraindications for EV and CPI therapy: Use platinum-containing combination chemotherapy (cisplatin or carboplatin plus gemcitabine).
Offer antibody-drug conjugate enfortumab vedotin.
If actionable FGFR alterations and prior CPI: offer erdafitinib.
Consider single agent chemotherapy (docetaxel, paclitaxel, vinflunine).
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