Enfortumab Vedotin and Pembrolizumab in Untreated Advanced Urothelial Cancer.

Fecha de publicación:

Autores de IDIVAL

Autores ajenos al IDIVAL

  • Powles T
  • Valderrama BP
  • Gupta S
  • Bedke J
  • Kikuchi E
  • Hoffman-Censits J
  • Iyer G
  • Vulsteke C
  • Park SH
  • Shin SJ
  • Castellano D
  • Fornarini G
  • Li JR
  • Gümüs M
  • Mar N
  • Loriot Y
  • Fléchon A
  • Drakaki A
  • Narayanan S
  • Yu X
  • Gorla S
  • Homet Moreno B
  • van der Heijden MS
  • EV-302 Trial Investigators

Unidades

Abstract

BACKGROUND: No treatment has surpassed platinum-based chemotherapy in improving overall survival in patients with previously untreated locally advanced or metastatic urothelial carcinoma. METHODS: We conducted a phase 3, global, open-label, randomized trial to compare the efficacy and safety of enfortumab vedotin and pembrolizumab with the efficacy and safety of platinum-based chemotherapy in patients with previously untreated locally advanced or metastatic urothelial carcinoma. Patients were randomly assigned in a 1:1 ratio to receive 3-week cycles of enfortumab vedotin (at a dose of 1.25 mg per kilogram of body weight intravenously on days 1 and 8) and pembrolizumab (at a dose of 200 mg intravenously on day 1) (enfortumab vedotin-pembrolizumab group) or gemcitabine and either cisplatin or carboplatin (determined on the basis of eligibility to receive cisplatin) (chemotherapy group). The primary end points were progression-free survival as assessed by blinded independent central review and overall survival. RESULTS: A total of 886 patients underwent randomization: 442 to the enfortumab vedotin-pembrolizumab group and 444 to the chemotherapy group. As of August 8, 2023, the median duration of follow-up for survival was 17.2 months. Progression-free survival was longer in the enfortumab vedotin-pembrolizumab group than in the chemotherapy group (median, 12.5 months vs. 6.3 months; hazard ratio for disease progression or death, 0.45; 95% confidence interval [CI], 0.38 to 0.54; P<0.001), as was overall survival (median, 31.5 months vs. 16.1 months; hazard ratio for death, 0.47; 95% CI, 0.38 to 0.58; P<0.001). The median number of cycles was 12 (range, 1 to 46) in the enfortumab vedotin-pembrolizumab group and 6 (range, 1 to 6) in the chemotherapy group. Treatment-related adverse events of grade 3 or higher occurred in 55.9% of the patients in the enfortumab vedotin-pembrolizumab group and in 69.5% of those in the chemotherapy group. CONCLUSIONS: Treatment with enfortumab vedotin and pembrolizumab resulted in significantly better outcomes than chemotherapy in patients with untreated locally advanced or metastatic urothelial carcinoma, with a safety profile consistent with that in previous reports. (Funded by Astellas Pharma US and others; EV-302 ClinicalTrials.gov number, NCT04223856.).

Copyright © 2024 Massachusetts Medical Society.

Datos de la publicación

ISSN/ISSNe:
0028-4793, 1533-4406

NEW ENGLAND JOURNAL OF MEDICINE  MASSACHUSETTS MEDICAL SOC

Tipo:
Article
Páginas:
875-888

Citas Recibidas en Web of Science: 134

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