Philip J. Saylor, MD, Attending Physician at Massachusetts General Hospital and Assistant Professor at Harvard Medical School, Boston, commented on this study.
“The results presented are clearly exciting and cause us to look forward to a likely phase III study of this strategy. The high response rate is striking, as it is clearly beyond what we would expect with pembrolizumab or enfortumab vedotin alone. We have been living in an immunotherapy era with some spectacular responses but also frustration that they occur in a minority of patients. In the field, we are eager to figure out the right agent or agents to pair with PD-1/PD-L1 checkpoint blockade to make the great responses the rule rather than the exception. The early efficacy of this combination seems to suggest real synergy between the two agents,” Dr. Saylor said.
Philip J. Saylor, MD
When asked about the cost of the combination, he replied: “Cost is always an important consideration, though we discuss it selectively. As a clinician, I recognize it’s an incredibly important issue for my patients and for our health-care system. I also recognize that I, like many oncologists, am an amateur within this realm.”
Some hurdles remain before this combination can go forward. “Toxicity will be an important consideration to follow as we develop a larger experience treating patients with this combination. Fatigue, hair loss, and neuropathy seemed to be the most prominent adverse events in this relatively small study. There are substantial potential toxicities of each of these systemic agents individually, and there is surely potential for a negative side-effect synergy between the two. We will definitely need to stay tuned on this front,” Dr. Saylor said.
DISCLOSURE: Dr. Saylor has received institutional research funding from Bayer.
It may be possible to use a platinum-free combination as first-line treatment for advanced or metastatic urothelial carcinoma in cisplatin-ineligible patients, if the results of the phase Ib/II EV-103 trial hold up. The combination of the newly approved antibody-drug conjugate (enfortumab vedotin)...