Managing Toxicity in Urothelial Cancer Treatment with Enfortumab Vedotin Plus Pembrolizumab

Dr. Jonathan E. Rosenberg, Chief of the Genitourinary Oncology Service at Memorial Sloan Kettering Cancer Center, shares insights on the administration and toxicity considerations when using enfortumab vedotin-ejfv (Padcev) in combination with pembrolizumab (Keytruda) for patients with urothelial cancer in community practice.

The combination of enfortumab vedotin and pembrolizumab follows a 3-week schedule, different from the 4-week schedule for enfortumab vedotin monotherapy. Dr. Rosenberg highlights the importance of close monitoring, especially in the early stages of treatment when severe skin toxicities can occur. While daily visits may not be needed after initial cycles, vigilant monitoring is crucial to quickly address any potential life-threatening side effects that may arise.

Dr. Rosenberg notes that peripheral neuropathy can become a concern as treatment progresses, particularly in patients with prolonged responses. Dose adjustments can help manage neuropathy and enhance treatment tolerability for affected individuals.

Effective management of skin toxicities is essential, and Dr. Rosenberg recommends collaborating with a dermatologist to implement strategies like topical steroids for control. With proper care and dose modifications, most patients can continue treatment successfully, even if temporary breaks are required to address any toxicities.

In conclusion, Dr. Rosenberg stresses the importance of proactive monitoring, timely interventions, and collaborative management to ensure the safety and tolerability of combination therapies like enfortumab vedotin and pembrolizumab for patients with advanced cancer.