Treatment of Advanced or Metastatic Upper Urinary Tract Urothelial Carcinoma Eligible for Enfortumab Vedotin plus Pembrolizumab

This protocol covers upper urinary tract urothelial carcinoma presenting as advanced or metastatic disease — specifically patients with distant metastases or unresectable lymph node metastases who are eligible for enfortumab vedotin combined with pembrolizumab as a first-line approach.

Clinical scenario

Enfortumab vedotin plus pembrolizumab is offered as first-line treatment to patients with advanced or metastatic upper urinary tract urothelial carcinoma. This combination has demonstrated significant improvements in both progression-free survival and overall survival, with a response rate of 68%.

Treatment approach (partial)

For select patients, molecularly targeted therapy directed at specific genomic alterations may be considered, alongside an alternative agent for those in whom certain systemic options are not feasible.

The complete regimen, eligibility criteria, sequencing, and full options are available in the structured protocol below.

Instant Access to Structured Evidence-Based Regimens

References

Offer EV +P as first-line treatment to patients with advanced/metastatic disease.
This study showed significant improvements in both progression-free survival and OS, with a response rate of 68% for EV + P.
Offer erdafitinib as an alternative subsequent-line therapy to patients: Previously treated with platinum-containing chemotherapy; Who had disease progression during or after treatment with a PD-1 or PD-L1 inhibitor; Who harbour FGFR DNA genomic alterations (FGFR2/3 mutations or FGFR3 fusions).
Only offer vinflunine as a second-line treatment to patients with metastatic disease if immunotherapy or combination chemotherapy is not feasible.

DOI: 10.1016/j.eururo.2025.02.023

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