Urothelial Post-ICI — SCE Medical Oncology MCQ

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ModerateUrological CancersUrothelial Post-ICISCE Medical Oncology

A 62-year-old man with metastatic urothelial carcinoma achieves a response to first-line gemcitabine-cisplatin and then avelumab maintenance. After 18 months of avelumab, he develops progressive disease. What second-line option is available?

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Correct answer: B — Enfortumab vedotin

Enfortumab vedotin (anti-Nectin-4 ADC) is approved for locally advanced/metastatic urothelial carcinoma after prior platinum and PD-1/PD-L1 inhibitor therapy (NICE TA833, EV-301 trial). This patient has received both platinum (gemcitabine-cisplatin) and PD-L1 inhibitor (avelumab maintenance), making enfortumab vedotin the standard next option. EV-301 showed significant OS benefit over chemotherapy. Erdafitinib is an option for FGFR-altered tumours.

Reference: NICE TA833 Enfortumab vedotin; EV-301 Powles et al NEJM 2021