Bladder Cancer — SCE Medical Oncology MCQ

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ModerateUrological CancersBladder CancerSCE Medical Oncology

A 62-year-old man with previously untreated metastatic urothelial carcinoma is cisplatin-eligible. What is the new standard first-line systemic therapy based on the EV-302 trial?

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Correct answer: D — Enfortumab vedotin + pembrolizumab

The EV-302/KEYNOTE-A39 trial demonstrated that enfortumab vedotin (anti-Nectin-4 ADC) plus pembrolizumab doubled both PFS and OS compared with platinum-based chemotherapy in first-line advanced urothelial carcinoma (NICE TA1097). This combination is now the standard first-line treatment regardless of cisplatin eligibility or PD-L1 status, representing a paradigm shift from platinum-based chemotherapy.

Reference: NICE TA1097 Enfortumab vedotin with pembrolizumab for untreated advanced urothelial cancer; EV-302 Powles et al NEJM 2024