Enfortumab vedotin monotherapy, enfortumab vedotin plus pembrolizumab, and immune checkpoint inhibitor-based neoadjuvant therapy for muscle-invasive bladder cancer: A systematic review and meta-analysis.
Shugo Yajima, Soichiro Yoshida, Naoki Imasato et al.
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In 30 seconds
This systematic review and meta-analysis evaluated the efficacy of neoadjuvant enfortumab vedotin (EV) monotherapy, EV plus pembrolizumab (EV+P), and immune checkpoint inhibitor (ICI)-based therapies in muscle-invasive bladder cancer (MIBC). The analysis included 15 trials with a total of 1,545 patients. The pooled pathological complete response (pCR) rate was 57% for EV+P, significantly higher than 37% for ICI-based regimens (P < .0001).
Key findings
- Pooled pCR was 57% for EV+P, 37% for ICI-based regimens, and 36% for EV monotherapy.
- In cisplatin-ineligible patients, EV+P pCR was 57%, compared to 29% for ICI-based therapies.
- Pooled radical cystectomy completion rate was 89%.
- EV+P showed event-free survival HR of 0.40 and overall survival HR of 0.50 compared to surgery alone.
Why it matters
The findings suggest that EV+P may offer superior pathological response rates and survival benefits compared to traditional ICI-based therapies in MIBC, particularly for patients ineligible for cisplatin. This could influence treatment decisions in the neoadjuvant setting.