Recent research shows that the combination of two bladder cancer medications — enfortumab vedotin (Padcev) and pembrolizumab (Keytruda) — may treat advanced bladder cancer better than standard platinum-based chemotherapy.
Enfortumab Vedotin Plus Pembrolizumab (EVP)
Enfortumab, an antibody-drug conjugate, attaches to cancer cells and delivers medication that destroys them. Pembrolizumab is an immune checkpoint inhibitor — a type of immunotherapy that helps your body’s natural defenses attack cancer cells.
Both drugs are approved by the U.S. Food and Drug Administration (FDA) for treatment of advanced bladder cancer. But in 2023, the FDA approved combined enfortumab vedotin plus pembrolizumab (EVP) to treat bladder cancer in those who aren’t eligible for cisplatin chemotherapy due to certain health conditions like heart failure.
Since then, studies have continued to show treatment success with EVP, and now you can get this treatment first — regardless of your ability to take cisplatin. In fact, many specialists now consider EVP a leading first‑line option for eligible patients, Dr. Gellhaus says.
Benefits of EVP
“One of the major advantages of EVP is that it delivers strong anti‑cancer activity while maintaining — and in some cases improving — patients’ quality of life compared with standard chemotherapy,” says Gellhaus.
“The biggest benefit of EV + P is improvement in survival,” says Dr. Wee — a view confirmed by recent research studies.
What the Research Shows
In one study, 886 people with advanced urothelial carcinoma took either EVP or platinum-based chemotherapy. Those who took EVP had almost double the survival time of those who were treated with chemo.
In another study of 195 people with advanced bladder cancer, about 3 out of 4 who took EVP experienced disease control. This means their tumor disappeared, shrank, or stopped growing.
“In clinical studies, many patients [also] reported stable or improved day‑to‑day well‑being on EVP, while traditional chemotherapy was more often associated with worse overall health and symptoms,” says Gellhaus.
Who Can Take EVP?
Most adults with metastatic urothelial carcinoma can take EVP. Prescribing information for both enfortumab vedotin and pembrolizumab lists important warnings and precautions.
Risks include:
- Allergic or infusion-related reactions
- Severe skin reactions
- High blood sugar
- Lung inflammation
- Numbness or tingling in your hands and feet (peripheral neuropathy)
- Immune system problems which can lead to infections
- Eye or vision problems
Both medications can also cause harm to a developing fetus, so you shouldn’t take them while pregnant or breastfeeding. You may also be unable to take EVP if you have:
- Neuropathy
- Liver failure
- Prior radiation for bladder cancer
- Active hepatitis A or B infection
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