Introduction

The therapeutic landscape of metastatic urothelial carcinoma (mUC) becomes increasingly dense: standard therapy remains cisplatin-based chemotherapy, followed by immunotherapy with checkpoint inhibitors as maintenance or second-line. New directions include erdafitinib, a fibroblast-growth factor receptor (FGFR) inhibitor in patients with corresponding mutations in FGFR2/3 receptor. Enfortumab vedotin (EV) is an antibody-drug conjugate targeting nectin-4 and is conjugated with monomethyl auristatin E (MMAE). It received FDA approval based on phase I/II data recently and thus represents an alternative to established third-line chemotherapies with vinflunine, paclitaxel or docetaxel.

Areas covered

The aim of this review is to evaluate the added value of Enfortumab vedotin in the therapeutic landscape of mUC. Current therapeutic options and alternatives for the affected patients are described, followed by a detailed description of the characteristics and available results of EV. Ongoing studies are explained, the present significance of the substance is assessed and its further future potential is outlined.

Expert opinion

Enfortumab vedotin has shown encouraging efficacy and a good tolerability in phase I/II trials, especially in heavily pretreated patients and patients with liver metastases. It appears to outperform third-line chemotherapies; ongoing studies will show the future potential of EV in treatment sequence.

中文翻译：

---

Enfortumab Vedotin –改变尿路上皮癌的下一个游戏规则

介绍

转移性尿路上皮癌（mUC）的治疗前景日益浓密：标准疗法仍然是基于顺铂的化学疗法，其次是采用检查点抑制剂作为维持或二线免疫疗法。新的方向包括erdafitinib，一种具有FGFR2 / 3受体相应突变的患者的成纤维细胞生长因子受体（FGFR）抑制剂。Enfortumab vedotin（EV）是靶向nectin-4的抗体-药物偶联物，与单甲基澳瑞他汀E（MMAE）偶联。它最近根据I / II期数据获得了FDA的批准，因此代表了用长春氟宁，紫杉醇或多西他赛替代已建立的三线化疗。

覆盖区域

这篇综述的目的是评估恩富妥单抗蛋白在mUC的治疗领域中的附加价值。描述了针对受影响患者的当前治疗选择和替代方法，然后详细介绍了EV的特征和可用结果。解释了正在进行的研究，评估了该物质的当前重要性，并概述了其进一步的未来潜力。

专家意见

Enfortumab vedotin在I / II期试验中显示出令人鼓舞的疗效和良好的耐受性，尤其是在经过大量预处理的患者和肝转移患者中。它似乎胜过三线化疗。正在进行的研究将显示电动汽车在治疗序列中的未来潜力。