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Nakagawa R, Izumi K, Toriumi R, Aoyama S, Kamijima T, Kano H, Makino T, Naito R, Iwamoto H, Yaegashi H, Kawaguchi S, Shigehara K, Nohara T, Mizokami A. Therapeutic efficacy and safety of biweekly administration of enfortumab vedotin for urothelial carcinoma. Jpn J Clin Oncol 2024:hyae101. [PMID: 39077841 DOI: 10.1093/jjco/hyae101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 07/16/2024] [Indexed: 07/31/2024] Open
Abstract
OBJECTIVES Enfortumab vedotin (EV) is an established pharmacotherapy for metastatic urothelial carcinoma (mUC); however, its adverse events (AEs) cannot be overlooked. The study investigated the efficacy and safety of biweekly EV administration. METHODS Patients with mUC who received EV at our institution were included in the study. Eligible patients were classified into two groups as follows: those who received EV on a standard schedule (standard group) and those who received EV on a biweekly schedule (biweekly group); the treatment outcomes and AEs between the two groups were compared. RESULTS Nine and 19 patients were in the standard group and biweekly groups, respectively. The progression-free survival, overall survival, and overall response rate were not significantly different between the two groups. AEs following EV administration, such as decreased appetite (P < .01), pruritus (P < .01), rash maculopapular (P < .01), anemia (P = .04), and liver dysfunction (P = .04), were significantly more frequent in the standard group. Grade 3 or higher AEs, such as pruritus (P = .03) and rash maculopapular (P < .01), were significantly more frequent in the standard group. Furthermore, significantly more patients in the standard group had to be given a reduced dose due to adverse events (P = .02). CONCLUSIONS Biweekly administration of EV may be safer without compromising therapeutic efficacy than the standard schedule.
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Affiliation(s)
- Ryunosuke Nakagawa
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Ren Toriumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Shuhei Aoyama
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Taiki Kamijima
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Hiroshi Kano
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Tomoyuki Makino
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Renato Naito
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Hiroaki Iwamoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Hiroshi Yaegashi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Shohei Kawaguchi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Takahiro Nohara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
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Matsubara N, Miura Y, Nishiyama H, Taoka R, Kojima T, Shimizu N, Hwang J, Ote T, Oyama R, Toyoizumi K, Mukhopadhyay S, Triantos S, Deprince K, Loriot Y. Phase 3 THOR Japanese subgroup analysis: erdafitinib in advanced or metastatic urothelial cancer and fibroblast growth factor receptor alterations. Int J Clin Oncol 2024:10.1007/s10147-024-02583-3. [PMID: 39017806 DOI: 10.1007/s10147-024-02583-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 07/02/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND In the THOR trial (NCT03390504) Cohort 1, erdafitinib demonstrated significantly prolonged overall survival (OS) (median 12.1 versus 7.8 months) and reduced risk of death by 36% (hazard ratio 0.64, P = 0.005) compared with chemotherapy in metastatic urothelial carcinoma (mUC) patients with FGFR alterations who progressed after ≥ 1 prior treatments, including anti-PD-(L)1. There have been no reports of the Japanese subgroup results yet. METHODS THOR Cohort 1 randomized patients to erdafitinib once daily or docetaxel/vinflunine once every 3 weeks. Primary endpoint was OS. Secondary endpoints included progression-free survival (PFS) and objective response rate (ORR). No specific statistical power was set for this Japanese subgroup analysis. RESULTS Of 266 patients randomized, 27 (14 erdafitinib; 13 chemotherapy) were Japanese. Baseline characteristics were generally similar between treatments and to the overall population, except for more males, lower body weight, and more upper tract primary tumors among Japanese patients. Compared with chemotherapy, erdafitinib showed improved OS (median 25.4 versus 12.4 months), PFS (median 8.4 versus 2.9 months) and ORR (57.1% versus 15.4%). Any grade treatment-related adverse events (AEs) occurred in all patients from both arms but Grade 3/4 AEs and AEs leading to discontinuation were lower in the erdafitinib arm. No new safety signals were observed in the Japanese subgroup. CONCLUSION In the Japanese subgroup, erdafitinib showed improved survival and response compared to chemotherapy, with no new safety concerns. These results support erdafitinib as a treatment option for Japanese mUC patients with FGFR alterations, and early FGFR testing after diagnosis of mUC should be considered.
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Affiliation(s)
- Nobuaki Matsubara
- Department of Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
| | - Yuji Miura
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Hiroyuki Nishiyama
- Department of Urology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Rikiya Taoka
- Department of Urology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Takahiro Kojima
- Department of Urology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Nobuaki Shimizu
- Department of Urology, Gunma Prefectural Cancer Center, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Jason Hwang
- Department of Medical Affairs, Janssen Pharmaceutical K.K, 5-2-3 Nishikanda, Chiyoda-ku, Tokyo, 101-0065, Japan
| | - Tatsuya Ote
- Oncology Clinical Development Department, Clinical Science Division, Research and Development, Janssen Pharmaceutical K.K, 5-2-3 Nishikanda, Chiyoda-ku, Tokyo, 101-0065, Japan
| | - Ryo Oyama
- Research and Development, Janssen Pharmaceutical K.K, 5-2-3 Nishikanda, Chiyoda-ku, Tokyo, 101-0065, Japan
| | - Kiichiro Toyoizumi
- Statistics and Decision Sciences, Research and Development, Janssen Pharmaceutical K. K, 5-2-3 Nishikanda, Chiyoda-ku, Tokyo, 101-0065, Japan
| | - Sutapa Mukhopadhyay
- Janssen Research and Development, 920 US Highway 202 S, Raritan, NJ, 08807, USA
| | - Spyros Triantos
- Janssen Research and Development, 1400 McKean Road, Spring House, PA, 19477, USA
| | - Kris Deprince
- Janssen Research and Development, Turnhoutseweg 30, 2340, Beerse Anterwerpen, Belgium
| | - Yohann Loriot
- Department of Cancer Medicine, INSERM U981, Gustave Roussy, Universite Paris-Saclay, 94800, Villejuif, France
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3
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Hayakawa N, Kikuchi E, Kaneko G, Yamashita R, Ikarashi D, Endo Y, Usui K, Obara W, Oyama M, Kondo Y. Association between response to enfortumab vedotin and peripheral neuropathy in urothelial carcinoma patients: a multicenter retrospective study. Jpn J Clin Oncol 2024:hyae082. [PMID: 38943559 DOI: 10.1093/jjco/hyae082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 06/14/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Enfortumab vedotin (EV) was approved for patients with metastatic urothelial carcinoma (mUC) who progressed after anticancer therapy on September 2021 in Japan. The association between the occurrence of EV-related side effects and clinical outcome remains to be elucidated. METHODS We identified 97 mUC patients treated with EV therapy at our five institutions from the date of approval to March 2023. The median follow-up period was 7.0 months. We retrospectively analyzed the efficacy and safety of EV. RESULTS The median age of the patients was 71 years old, 39% had PS of 1 or more, and 56.7% had primary tumor in upper urinary tract. Overall response rate (ORR) to EV therapy, median progression-free survival (PFS), and overall survival (OS) were 43.3%, 7.52 months, and 12.78 months, respectively. Any grade of treatment-related skin disorder, dysgeusia, peripheral neuropathy, gastrointestinal disorder, and hyperglycemia occurred in 61 (62.9%), 36 (37.1%), 34 (35.1%), 29 (29.9%), and 18 (18.6%) patients, respectively. The patients with EV-associated peripheral neuropathy had significantly higher ORR (58.8% vs. 34.9%, P = .032) and longer median PFS (8.05 vs. 6.31 months, P = .017) and OS (not reached vs. 11.57 months, P = .008, respectively) than those without. The occurrence of peripheral neuropathy after EV treatment and the presence of peritoneal dissemination were factors independently associated with PFS (hazard ratio = 0.46, P = .008 and hazard raito = 3.83, P = .004, respectively) and OS (hazard ratio = 0.30, P = .005 and hazard raito = 4.53, P = .002, respectively). CONCLUSIONS The occurrence of EV-related peripheral neuropathy might be associated with the efficacy of EV therapy in mUC patients.
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Affiliation(s)
- Nozomi Hayakawa
- Department of Urology, St. Marianna University School of Medicine, Kanagawa, Kanagawa, Japan
| | - Eiji Kikuchi
- Department of Urology, St. Marianna University School of Medicine, Kanagawa, Kanagawa, Japan
| | - Go Kaneko
- Department of Uro-Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Ryo Yamashita
- Division of Urology, Shizuoka Cancer Center, Suntougun, Shizuoka, Japan
| | - Daiki Ikarashi
- Department of Urology, Iwate Medical University School of Medicine, Iwate, Japan
| | - Yuki Endo
- Department of Urology, Nippon Medical School, Tokyo, Japan
| | - Kimitsugu Usui
- Division of Urology, Shizuoka Cancer Center, Suntougun, Shizuoka, Japan
| | - Wataru Obara
- Department of Urology, Iwate Medical University School of Medicine, Iwate, Japan
| | - Masafumi Oyama
- Department of Uro-Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yukihiro Kondo
- Department of Urology, Nippon Medical School, Tokyo, Japan
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4
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Ren JW, Chen ZY, Bai YJ, Han P. Efficacy and safety of antibody-drug conjugates in the treatment of urothelial cell carcinoma: a systematic review and meta-analysis of prospective clinical trials. Front Pharmacol 2024; 15:1377924. [PMID: 38933670 PMCID: PMC11199396 DOI: 10.3389/fphar.2024.1377924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/13/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction: Urothelial carcinoma (UC) is a refractory disease for which achieving satisfactory outcomes remains challenging with current surgical interventions. Antibody-drug conjugates (ADCs) are a novel class of targeted therapeutics that have demonstrated encouraging results for UC. Although there is a limited number of high-quality randomized control trials (RCTs) examining the use of ADCs in patients with UC, some prospective non-randomized studies of interventions (NRSIs) provide valuable insights and pertinent information. We aim to assess the efficacy and safety of ADCs in patients with UC, particularly those with locally advanced and metastatic diseases. Methods: A systematic search was conducted across PubMed, Embase, the Cochrane Library, and Web of Science databases to identify pertinent studies. Outcomes, such as the overall response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), adverse events (AEs), and treatment-related adverse events (TRAEs), were extracted for further analyses. Results: Twelve studies involving 1,311 patients were included in this meta-analysis. In terms of tumor responses, the pooled ORR and DCR were 40% and 74%, respectively. Regarding survival analysis, the pooled median PFS and OS were 5.66 months and 12.63 months, respectively. The pooled 6-month PFS and OS were 47% and 80%, while the pooled 1-year PFS and OS were 22% and 55%, respectively. The most common TRAEs of the ADCs were alopecia (all grades: 45%, grades ≥ III: 0%), decreased appetite (all grades: 34%, grades ≥ III: 3%), dysgeusia (all grades: 40%, grades ≥ III: 0%), fatigue (all grades: 39%, grades ≥ III: 5%), nausea (all grades: 45%, grades ≥ III: 2%), peripheral sensory neuropathy (all grades: 37%, grades ≥ III: 2%), and pruritus (all grades: 32%, grades ≥ III: 1%). Conclusion: The meta-analysis in this study demonstrates that ADCs have promising efficacies and safety for patients with advanced or metastatic UC. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42023460232.
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Affiliation(s)
- Jun-Wei Ren
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
- Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ze-Yu Chen
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
- Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yun-Jin Bai
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
- Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Han
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
- Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
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5
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Uemura K, Ito H, Jikuya R, Kondo T, Tatenuma T, Kawahara T, Ito Y, Komeya M, Muraoka K, Hasumi H, Uemura H, Makiyama K. Enfortumab vedotin prolongs overall survival in metastatic urothelial carcinoma following pembrolizumab therapy in real-world data. Int J Urol 2024; 31:678-684. [PMID: 38402449 DOI: 10.1111/iju.15437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/14/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE In December 2021, enfortumab vedotin (EV), an antibody-drug conjugate directed against nectin-4, was approved in Japan as a new treatment after platinum-containing chemotherapy and PD-1/PD-L1 inhibitors. This study evaluated, using real-world data, the efficacy and safety of EV therapy in patients with metastatic urothelial carcinoma (mUC). MATERIALS AND METHODS Fifty-five patients with mUC who discontinued pembrolizumab therapy due to disease progression between June 2018 and April 2023 at Yokohama City University Hospital were evaluated retrospectively. Of the 55 patients, 25 received EV therapy (EV group) and 30 did not (non-EV group). All patients who underwent EV therapy were diagnosed with disease progression after the approval of EV in Japan. RESULTS The median (range) follow-up period after pembrolizumab discontinuation was 6.3 (0.7-31.1) months. There were eight (32.0%) deaths due to cancer in the EV group and 27 (90.0%) in the non-EV group. The overall survival (OS) after pembrolizumab discontinuation was not reached in the EV group versus 2.6 months in the non-EV group (p < 0.001). A multivariate analysis revealed that EV therapy (EV vs. non-EV group; hazard ratio 0.26; 95% confidence interval 0.16-0.41; p < 0.001) was an independent prognostic factor for OS. CONCLUSION EV prolonged OS in mUC following pembrolizumab therapy in real-world data.
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MESH Headings
- Humans
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antibodies, Monoclonal, Humanized/adverse effects
- Male
- Female
- Aged
- Retrospective Studies
- Middle Aged
- Carcinoma, Transitional Cell/drug therapy
- Carcinoma, Transitional Cell/mortality
- Carcinoma, Transitional Cell/secondary
- Aged, 80 and over
- Antineoplastic Agents, Immunological/therapeutic use
- Antineoplastic Agents, Immunological/adverse effects
- Japan/epidemiology
- Urinary Bladder Neoplasms/drug therapy
- Urinary Bladder Neoplasms/mortality
- Urinary Bladder Neoplasms/pathology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal/adverse effects
- Urologic Neoplasms/drug therapy
- Urologic Neoplasms/mortality
- Urologic Neoplasms/pathology
- Disease Progression
- Survival Rate
- Immunoconjugates/therapeutic use
- Immunoconjugates/adverse effects
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Affiliation(s)
- Koichi Uemura
- Department of Urology, Yokohama City University Hospital, Kanagawa, Japan
| | - Hiroki Ito
- Department of Urology, Yokohama City University Hospital, Kanagawa, Japan
| | - Ryosuke Jikuya
- Department of Urology, Yokohama City University Hospital, Kanagawa, Japan
| | - Takuya Kondo
- Department of Urology, Yokohama City University Hospital, Kanagawa, Japan
| | - Tomoyuki Tatenuma
- Department of Urology, Yokohama City University Hospital, Kanagawa, Japan
| | - Takashi Kawahara
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Kanagawa, Japan
| | - Yusuke Ito
- Department of Urology, Yokohama City University Hospital, Kanagawa, Japan
| | - Mitsuru Komeya
- Department of Urology, Yokohama City University Hospital, Kanagawa, Japan
| | - Kentaro Muraoka
- Department of Urology, Yokohama City University Hospital, Kanagawa, Japan
| | - Hisashi Hasumi
- Department of Urology, Yokohama City University Hospital, Kanagawa, Japan
| | - Hiroji Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Kanagawa, Japan
| | - Kazuhide Makiyama
- Department of Urology, Yokohama City University Hospital, Kanagawa, Japan
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6
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Hara T, Matsushita Y, Harada K, Fujimoto N, Fujisawa M, Miyake H. Clinical outcomes in patients with advanced urothelial carcinoma treated with enfortumab vedotin: A retrospective multicenter study in Japan. Int J Urol 2024; 31:696-698. [PMID: 38424707 DOI: 10.1111/iju.15435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Takuto Hara
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuto Matsushita
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kenichi Harada
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Naohiro Fujimoto
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideaki Miyake
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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7
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Taoka R, Kamada M, Izumi K, Tanimoto R, Daizumoto K, Hayashida Y, Uematsu K, Arai H, Sano T, Saito R, Hirama H, Kobayashi T, Honda T, Osaki Y, Abe Y, Naito H, Tohi Y, Matsuoka Y, Kato T, Okazoe H, Ueda N, Sugimoto M. Peripheral neuropathy and nerve electrophysiological changes with enfortumab vedotin in patients with advanced urothelial carcinoma: a prospective multicenter cohort study. Int J Clin Oncol 2024; 29:602-611. [PMID: 38418804 DOI: 10.1007/s10147-024-02481-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Enfortumab vedotin is a novel antibody-drug conjugate used as a third-line therapy for the treatment of urothelial cancer. We aimed to elucidate the effect of enfortumab vedotin-related peripheral neuropathy on its efficacy and whether enfortumab vedotin-induced early electrophysiological changes could be associated with peripheral neuropathy onset. METHODS Our prospective multicenter cohort study enrolled 34 patients with prior platinum-containing chemotherapy and programmed cell death protein 1/ligand 1 inhibitor-resistant advanced urothelial carcinoma and received enfortumab vedotin. The best overall response, progression-free survival, overall survival, and safety were assessed. Nerve conduction studies were also performed in 11 patients. RESULTS The confirmed overall response rate and disease control rate were 52.9% and 73.5%, respectively. The median overall progression-free survival and overall survival were 6.9 and 13.5 months, respectively, during a median follow-up of 8.6 months. The patients with disease control had significantly longer treatment continuation and overall survival than did those with uncontrolled disease. Peripheral neuropathy occurred in 12.5% of the patients. The overall response and disease control rates were 83.3% and 100%, respectively: higher than those in patients without peripheral neuropathy (p = 0.028 and p = 0.029, respectively). Nerve conduction studies indicated that enfortumab vedotin reduced nerve conduction velocity more markedly in sensory nerves than in motor nerves and the lower limbs than in the upper limbs, with the sural nerve being the most affected in the patients who developed peripheral neuropathy (p = 0.011). CONCLUSION Our results indicated the importance of focusing on enfortumab vedotin-induced neuropathy of the sural nerve to maximize efficacy and improve safety.
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Affiliation(s)
- Rikiya Taoka
- Department of Urology, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan.
| | - Masaki Kamada
- Department of Neurological Intractable Disease Research, Kagawa University School of Medicine, Kita, Japan
| | - Kazuyoshi Izumi
- Department of Urology, Takamatsu Red Cross Hospital, Takamatsu, Japan
| | - Ryuta Tanimoto
- Department of Urology, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Kei Daizumoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yushi Hayashida
- Department of Urology, Sakaide City Hospital, Sakaide, Japan
| | | | - Hironobu Arai
- Department of Urology, Shodoshima Central Hospital, Shodoshima, Japan
| | - Takeshi Sano
- Department of Urology, Kansai Medical University, Hirakata, Japan
| | - Ryoichi Saito
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiromi Hirama
- Department of Urology, KKR Takamatsu Hospital, Takamatsu, Japan
| | - Toshihiro Kobayashi
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, Kita, Japan
| | - Tomoko Honda
- Department of Urology, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Yu Osaki
- Department of Urology, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Yohei Abe
- Department of Urology, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Hirohito Naito
- Department of Urology, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Yoichiro Tohi
- Department of Urology, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Yuki Matsuoka
- Department of Urology, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Takuma Kato
- Department of Urology, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Homare Okazoe
- Department of Urology, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Nobufumi Ueda
- Department of Urology, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Mikio Sugimoto
- Department of Urology, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
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8
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Morikawa T, Naiki T, Sugiyama Y, Naiki-Ito A, Nagai T, Etani T, Iida K, Isobe T, Noda Y, Shimizu N, Aoki M, Gonda M, Banno R, Kubota H, Ando R, Umemoto Y, Kawai N, Yasui T. C-Reactive Protein Is a Potential Prognostic Marker in Patient with Advanced or Metastatic Urothelial Carcinoma Treated with Enfortumab Vedotin: A Multi-Center Retrospective Study. Cancers (Basel) 2024; 16:1725. [PMID: 38730675 PMCID: PMC11083374 DOI: 10.3390/cancers16091725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND In the EV-301 trial, enfortumab vedotin prolonged survival in patients with locally advanced or metastatic urothelial carcinoma previously treated with platinum-based therapy and programmed cell death 1/programmed death-ligand 1 inhibitor. However, real-world Asian data are limited, and potential prognostic markers are non-existent. We aimed to investigate potential prognostic markers for enfortumab vedotin therapy in Asian patients. METHODS We retrospectively enrolled 61 Japanese patients treated with enfortumab vedotin therapy at our hospital and affiliated hospitals between January 2019 and September 2023. RESULTS Enrolled patients (38 men, 23 women; median age 74 [IQR: 68-79] years) had bladder cancer (26 patients) or upper-tract urothelial carcinoma (35 patients). Fifty-four patients reported adverse events (grade >3 in 12). Skin disorders, pruritus, and neuropathy were common adverse effects. The median overall survival was 17.1 months (95% confidence interval: 10.0-not applicable). In multivariate analysis, the C-reactive protein level was an independent marker predicting favorable overall survival with enfortumab vedotin. Patient characteristics did not differ between C-reactive protein-high and -low groups. CONCLUSIONS Our study provides real-world data showing that enfortumab vedotin prolonged survival in Asian patients similar to the EV-301 trial. Additionally, the C-reactive protein level might be considered a prognostic marker of enfortumab vedotin therapy in such patients.
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Affiliation(s)
- Toshiharu Morikawa
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.I.); (T.I.); (Y.N.); (N.S.); (M.A.); (M.G.); (R.A.); (Y.U.); (N.K.); (T.Y.)
| | - Taku Naiki
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.I.); (T.I.); (Y.N.); (N.S.); (M.A.); (M.G.); (R.A.); (Y.U.); (N.K.); (T.Y.)
- Department of Urology, Nagoya City University West Medical Center, Nagoya 467-8601, Japan
| | - Yosuke Sugiyama
- Department of Pharmacy, Nagoya City University Hospital, Nagoya 467-8601, Japan;
| | - Aya Naiki-Ito
- Department of Experimental Pathology and Tumor Biology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan;
| | - Takashi Nagai
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.I.); (T.I.); (Y.N.); (N.S.); (M.A.); (M.G.); (R.A.); (Y.U.); (N.K.); (T.Y.)
| | - Toshiki Etani
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.I.); (T.I.); (Y.N.); (N.S.); (M.A.); (M.G.); (R.A.); (Y.U.); (N.K.); (T.Y.)
| | - Keitaro Iida
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.I.); (T.I.); (Y.N.); (N.S.); (M.A.); (M.G.); (R.A.); (Y.U.); (N.K.); (T.Y.)
| | - Teruki Isobe
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.I.); (T.I.); (Y.N.); (N.S.); (M.A.); (M.G.); (R.A.); (Y.U.); (N.K.); (T.Y.)
| | - Yusuke Noda
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.I.); (T.I.); (Y.N.); (N.S.); (M.A.); (M.G.); (R.A.); (Y.U.); (N.K.); (T.Y.)
- Department of Urology, Anjo Kosei Hospital, Anjo 446-8602, Japan
| | - Nobuhiko Shimizu
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.I.); (T.I.); (Y.N.); (N.S.); (M.A.); (M.G.); (R.A.); (Y.U.); (N.K.); (T.Y.)
| | - Maria Aoki
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.I.); (T.I.); (Y.N.); (N.S.); (M.A.); (M.G.); (R.A.); (Y.U.); (N.K.); (T.Y.)
- Department of Urology, Nagoya City University West Medical Center, Nagoya 467-8601, Japan
| | - Masakazu Gonda
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.I.); (T.I.); (Y.N.); (N.S.); (M.A.); (M.G.); (R.A.); (Y.U.); (N.K.); (T.Y.)
| | - Rika Banno
- Department of Urology, Konan Hospital, Konan 483-8704, Japan;
| | - Hiroki Kubota
- Department of Urology, Kainan Hospital, Yatomi 498-8502, Japan;
| | - Ryosuke Ando
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.I.); (T.I.); (Y.N.); (N.S.); (M.A.); (M.G.); (R.A.); (Y.U.); (N.K.); (T.Y.)
| | - Yukihiro Umemoto
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.I.); (T.I.); (Y.N.); (N.S.); (M.A.); (M.G.); (R.A.); (Y.U.); (N.K.); (T.Y.)
- Department of Urology, Nagoya City University West Medical Center, Nagoya 467-8601, Japan
| | - Noriyasu Kawai
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.I.); (T.I.); (Y.N.); (N.S.); (M.A.); (M.G.); (R.A.); (Y.U.); (N.K.); (T.Y.)
| | - Takahiro Yasui
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.I.); (T.I.); (Y.N.); (N.S.); (M.A.); (M.G.); (R.A.); (Y.U.); (N.K.); (T.Y.)
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9
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Nathan P, Rajeh A, Noor M, Boldt G, Fernandes R. Antibody-Drug Conjugates in the Treatment of Genitourinary Cancers: An Updated Review of Data. Curr Oncol 2024; 31:2316-2327. [PMID: 38668075 PMCID: PMC11049516 DOI: 10.3390/curroncol31040172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/14/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
The treatment landscape of genitourinary cancers has significantly evolved over the past few years. Renal cell carcinoma, bladder cancer, and prostate cancer are the most common genitourinary malignancies. Recent advancements have produced new targeted therapies, particularly antibody-drug conjugates (ADCs), due to a better understanding of the underlying oncogenic factors and molecular mechanisms involved. ADCs function as a 'drug delivery into the tumor' system. They are composed of an antigen-directed antibody linked to a cytotoxic drug that releases cytotoxic components after binding to the tumor cell's surface antigen. ADCs have been proven to be extremely promising in the treatment of several cancer types. For GU cancers, this novel treatment has only benefited patients with metastatic urothelial cancer (mUC). The rest of the GU cancer paradigm does not have any FDA-approved ADC treatment options available yet. In this study, we have thoroughly completed a narrative review of the current literature and summarized preclinical studies and clinical trials that evaluated the utility, activity, and toxicity of ADCs in GU cancers, the prospects of ADC development, and the ongoing clinical trials. Prospective clinical trials, retrospective studies, case reports, and scoping reviews were included.
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Affiliation(s)
- Prathana Nathan
- Department of Internal Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5C1, Canada
| | - Adnan Rajeh
- Division of Medical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5C1, Canada;
| | - Meh Noor
- Department of Internal Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5C1, Canada
| | - Gabriel Boldt
- London Regional Cancer Program, Victoria Hospital, London Health Sciences Centre, London, ON N6A 5W9, Canada;
| | - Ricardo Fernandes
- Division of Medical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5C1, Canada;
- Cancer Research Laboratory Program, Lawson Health Research Institute, London, ON N6C 2R5, Canada
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10
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Miyake M, Nishimura N, Oda Y, Miyamoto T, Ohmori C, Takamatsu N, Itami Y, Tachibana A, Matsumoto Y, Kiba K, Tomioka A, Yamamoto H, Okajima E, Masaomi K, Sakamoto K, Tomizawa M, Shimizu T, Ohnishi K, Hori S, Morizawa Y, Gotoh D, Nakai Y, Torimoto K, Tanaka N, Fujimoto K. Enfortumab vedotin following platinum-based chemotherapy and immune checkpoint inhibitors for advanced urothelial carcinoma: response, survival and safety analysis from a multicentre real-world Japanese cohort. Jpn J Clin Oncol 2024; 54:329-338. [PMID: 38061911 DOI: 10.1093/jjco/hyad170] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/21/2023] [Indexed: 03/12/2024] Open
Abstract
OBJECTIVE Real-world evidence regarding enfortumab vedotin for unresectable or metastatic urothelial carcinoma is scarce, particularly in Japan. We investigated real-world data focusing on patient background, previous treatments, response, survival and adverse events in patients receiving enfortumab vedotin. METHODS A multicentre database was used to register 556 patients diagnosed with metastatic urothelial carcinoma from 2008 to 2023; 34 patients (6.1%) treated with enfortumab vedotin were included. Best radiographic objective responses were evaluated using the Response Evaluation Criteria in Solid Tumors (v1.1) during treatments. Overall survival and progression-free survival were estimated (Kaplan-Meier method). Toxicities were reported according to the Common Terminology Criteria for Adverse Events, version 5.0. The relative dose intensity, which could impact oncological outcomes, was calculated. RESULTS The median number of enfortumab vedotin therapy cycles was 5. The best objective response to enfortumab vedotin was partial response, stable disease and progressive disease in 19 (56%), 5 (15%) and 10 (29%) patients, respectively. The median overall survival and progression-free survival after the first enfortumab vedotin dose were 16 and 9 months, respectively. No significant relationship was observed between survival outcomes after enfortumab vedotin initiation and the enfortumab vedotin relative dose intensity. The median overall survival from first-line platinum-based chemotherapy initiation was 42 months. Twenty-six (76%) patients experienced any grade of enfortumab vedotin-related toxicities; eight (24%) experienced Grades 3-4 toxicities, the most common being skin toxicity (any grade, 47%; Grades 3-4, 12%). CONCLUSIONS Here, we report real-world evidence for enfortumab vedotin therapy in Japan. Tumour responses and safety profiles were comparable with those of clinical trials on this novel treatment.
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Affiliation(s)
- Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Nobutaka Nishimura
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
- Department of Urology, Hirao Hospital, Kashihara, Nara, Japan
| | - Yuki Oda
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | | | - Chihiro Ohmori
- Department of Urology, Nara Prefecture General Medical Center, Nara, Nara, Japan
| | - Norimi Takamatsu
- Department of Urology, Yamatotakada Municipal Hospital, Yamatotakada, Nara, Japan
| | - Yoshitaka Itami
- Department of Urology, Tane General Hospital, Osaka, Osaka, Japan
| | - Akira Tachibana
- Department of Urology, Hoshigaoka Medical Center, Hirakata, Osaka, Japan
| | | | - Keisuke Kiba
- Department of Urology, Kindai University Nara Hospital, Ikoma, Nara, Japan
| | - Atsushi Tomioka
- Department of Urology, Saiseikai Chuwa Hospital, Sakurai, Nara, Japan
| | - Hiroaki Yamamoto
- Department of Urology, Minami Nara Medical Center, Yoshino, Nara, Japan
| | - Eijiro Okajima
- Department of Urology, Nara City Hospital, Nara, Nara, Japan
| | - Kuwata Masaomi
- Department of Urology, Matsusaka Chuo General Hospital, Matsusaka, Mie, Japan
| | - Keichi Sakamoto
- Department of Urology, Osaka Kaisei Hospital, Osaka, Osaka, Japan
| | - Mitsuru Tomizawa
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Takuto Shimizu
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kenta Ohnishi
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
- Department of Prostate Brachytherapy, Nara Medical University, Kashihara, Nara, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
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11
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Aoki M, Naiki T, Naiki-Ito A, Morikawa T, Matsuyama N, Torii K, Kato T, Maruyama T, Inaguma S, Yasui T. Successful treatment with enfortumab-vedotin of metastatic signet ring cell cancer expressing nectin-4 and originating from the bladder. IJU Case Rep 2024; 7:110-114. [PMID: 38440703 PMCID: PMC10909144 DOI: 10.1002/iju5.12678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/24/2023] [Indexed: 03/06/2024] Open
Abstract
Introduction As an aggressive adenocarcinoma phenotype, primary signet ring cell carcinoma of the urinary bladder is an extremely rare variant. The prognosis of metastatic signet ring cell carcinoma of the urinary bladder is extremely poor and the clinical course for its specific pathogenesis remains unelucidated. Case presentation A 64-year-old Japanese male patient was diagnosed with invasive urothelial carcinoma with glandular differentiation of a signet ring cell-type with pT4aN0M0, and he was eventually diagnosed with metastatic signet ring cell carcinoma of the urinary bladder. He was initially responsive to systemic combination induction chemotherapy of S-1 and cisplatin followed by avelumab switch maintenance therapy; however, signet ring cell carcinoma of the urinary bladder relapse occurred in the pathological findings of a biopsy from the right thigh. Immunohistochemical analysis of this specimen identified strong positive staining for nectin-4 and, following enfortumab-vedotin treatment, the patient showed a good response. Conclusion We thus describe a rare case of metastatic signet ring cell carcinoma of the urinary bladder with nectin-4 expression diagnosed by a biopsy of a metastatic site.
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Affiliation(s)
- Maria Aoki
- Department of Nephro-urology Graduate School of Medical Sciences Nagoya City University Nagoya Japan
| | - Taku Naiki
- Department of Nephro-urology Graduate School of Medical Sciences Nagoya City University Nagoya Japan
| | - Aya Naiki-Ito
- Department of Experimental Pathology and Tumor Biology Graduate School of Medical Sciences Nagoya City University Nagoya Japan
| | - Toshiharu Morikawa
- Department of Nephro-urology Graduate School of Medical Sciences Nagoya City University Nagoya Japan
| | - Nayuka Matsuyama
- Department of Nephro-urology Graduate School of Medical Sciences Nagoya City University Nagoya Japan
| | - Koei Torii
- Department of Nephro-urology Graduate School of Medical Sciences Nagoya City University Nagoya Japan
| | - Taiki Kato
- Department of Urology Nagoya City University East Medical Center Nagoya Japan
| | - Tetsuji Maruyama
- Department of Urology Nagoya City University East Medical Center Nagoya Japan
| | - Shingo Inaguma
- Department of Experimental Pathology and Tumor Biology Graduate School of Medical Sciences Nagoya City University Nagoya Japan
| | - Takahiro Yasui
- Department of Nephro-urology Graduate School of Medical Sciences Nagoya City University Nagoya Japan
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12
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Domb C, Garcia JA, Barata PC, Mendiratta P, Rao S, Brown JR. Systematic review of recent advancements in antibody-drug and bicycle toxin conjugates for the treatment of urothelial cancer. Ther Adv Urol 2024; 16:17562872241249073. [PMID: 38779496 PMCID: PMC11110528 DOI: 10.1177/17562872241249073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/01/2024] [Indexed: 05/25/2024] Open
Abstract
Antibody-drug conjugates and bicycle toxin conjugates represent a tremendous advance in drug delivery technology and have shown great promise in the treatment of urothelial cancer. Previously approved systemic therapies, including chemotherapy and immunotherapy, are often impractical due to comorbidities, and outcomes for patients with advanced disease remain poor, even when receiving systemic therapy. In this setting, antibody-drug and bicycle toxin conjugates have emerged as novel treatments, dramatically altering the therapeutic landscape. These drugs harness unique designs consisting of antibody or bicycle peptide, linker, and cytotoxic payload with more targeted delivery than conventional chemotherapy, thus eliminating malignant cells while reducing systemic toxicities. Potential targets investigated in urothelial cancer include Nectin-4, TROP2, HER2, and EphA2. Initial clinical trials demonstrated efficacy in treatment of refractory advanced urothelial cancer, as well as improvement in quality of life. These initial studies led to FDA approval of two antibody-drug conjugates, enfortumab vedotin and sacituzumab govitecan. Moreover, antibody-drug and bicycle toxin conjugates are being studied in ongoing clinical trials in frontline treatment of advanced disease as well as for localized cancer. These studies highlight the potential for additional future therapies with novel targets, novel antibodies, cytotoxic and immunomodulatory payloads, and unique structural designs enhancing efficacy and safety. There is increasing evidence that combinations with other cancer therapies, especially immunotherapy, improve treatment outcomes. The combination of enfortumab vedotin and pembrolizumab was recently approved for first-line treatment of advanced urothelial carcinoma. Despite the great promise of these novel drugs, robust predictive biomarkers are needed to determine the patients who would maximally benefit. This review surveys the rationale and current state of the evidence for these new drugs and describes future directions actively being explored.
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Affiliation(s)
- Chaim Domb
- University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Jorge A. Garcia
- University Hospitals Seidman Cancer Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Pedro C. Barata
- University Hospitals Seidman Cancer Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Prateek Mendiratta
- University Hospitals Seidman Cancer Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Santosh Rao
- University Hospitals Seidman Cancer Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Jason R. Brown
- University Hospitals Seidman Cancer Center, 11100 Euclid Ave., Lakeside 1200, Mailstop LKS 5079, Cleveland, OH 44106, USA
- Case Western Reserve University, Cleveland, OH, USA
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13
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Duan X, Xia L, Zhang Z, Ren Y, Pomper MG, Rowe SP, Li X, Li N, Zhang N, Zhu H, Yang Z, Sheng X, Yang X. First-in-Human Study of the Radioligand 68Ga-N188 Targeting Nectin-4 for PET/CT Imaging of Advanced Urothelial Carcinoma. Clin Cancer Res 2023; 29:3395-3407. [PMID: 37093191 DOI: 10.1158/1078-0432.ccr-23-0609] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/05/2023] [Accepted: 04/19/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE Nectin-4 is an emerging biomarker for cancer diagnosis and therapy. Recently, enfortumab vedotin (EV) was approved by the FDA as the first nectin-4 targeting antibody-drug conjugate for treating advanced urothelial carcinoma (UC). A PET imaging method to noninvasively quantify nectin-4 expression level would potentially help to select patients most likely to respond to EV and predict the response. EXPERIMENTAL DESIGN In this study, we designed a bicyclic peptide-based nectin-4 targeting radiotracer 68Ga-N188. Initially, we performed preclinical evaluations of 68Ga-N188 in UC cell lines and xenograft mouse models. Next, we performed the translational study in healthy volunteers and a pilot cohort of patients with advanced UC on uEXPLORER total-body PET/CT. RESULTS In the preclinical study, 68Ga-N188 showed high affinity to nectin-4, specific uptake in a nectin-4(+) xenograft mouse model, and suitable pharmacokinetic and safety profiles. In the translational study, 2 healthy volunteers and 14 patients with advanced UC were enrolled. The pharmacokinetic profile was determined for 68Ga-N188, and the nectin-4 relative expression level in different organs was quantitatively imaged. CONCLUSIONS A clear correlation between PET SUV value and nectin-4 expression was observed, supporting the application of 68Ga-N188 PET as a companion diagnostic tool for optimizing treatments that target nectin-4. See related commentary by Jiang et al., p. 3259.
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Affiliation(s)
- Xiaojiang Duan
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Lei Xia
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
- Key Laboratory for Research and Evaluation of Radiopharmaceuticals, National Medical Products Administration (NMPA), Beijing, China
| | - Zhuochen Zhang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Yanan Ren
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
| | - Martin G Pomper
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Steven P Rowe
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Beijing, China
| | - Nan Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
- Key Laboratory for Research and Evaluation of Radiopharmaceuticals, National Medical Products Administration (NMPA), Beijing, China
| | - Ning Zhang
- Translational Cancer Research Center, Peking University First Hospital, Beijing, China
| | - Hua Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
- Key Laboratory for Research and Evaluation of Radiopharmaceuticals, National Medical Products Administration (NMPA), Beijing, China
| | - Zhi Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
- Key Laboratory for Research and Evaluation of Radiopharmaceuticals, National Medical Products Administration (NMPA), Beijing, China
| | - Xinan Sheng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xing Yang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
- Key Laboratory for Research and Evaluation of Radiopharmaceuticals, National Medical Products Administration (NMPA), Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- International Cancer Institute, Peking University Health Science Center, Beijing, China
- Yunnan Baiyao Group, Kunming, China
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14
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Kawahara T, Hasizume A, Uemura K, Yamaguchi K, Ito H, Takeshima T, Hasumi H, Teranishi JI, Ousaka K, Makiyama K, Uemura H. Administration of Enfortumab Vedotin after Immune-Checkpoint Inhibitor and the Prognosis in Japanese Metastatic Urothelial Carcinoma: A Large Database Study on Enfortumab Vedotin in Metastatic Urothelial Carcinoma. Cancers (Basel) 2023; 15:4227. [PMID: 37686503 PMCID: PMC10486515 DOI: 10.3390/cancers15174227] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Enfortumab vedotin shows promise as a targeted therapy for advanced urothelial carcinoma, particularly in patients who have previously received platinum-based chemotherapy and an immune-checkpoint inhibitor. The EV-301 phase III trial demonstrated significantly improved overall survival and response rates compared to standard chemotherapy. However, more data, especially from larger real-world studies, are needed to further assess its effectiveness in Japanese patients. METHODS A total of 6007 urothelial cancer patients inducted with pembrolizumab as a second-line treatment were analyzed. Among them, 563 patients received enfortumab vedotin after pembrolizumab, while 443 patients received docetaxel or paclitaxel after pembrolizumab, and all were included in the study for efficacy as a life prolonging agent. RESULTS The enfortumab vedotin group showed a longer overall survival than the paclitaxel/docetaxel group (p = 0.013, HR: 0.71). In multivariate analysis, enfortumab vedotin induction was the independent risk factor for overall survival (p = 0.013, HR: 0.70). There were no significant differences in cancer-specific survival. CONCLUSIONS Enfortumab vedotin prolonged the overall survival for Japanese advanced or metastatic urothelial carcinoma patients compared to paclitaxel or docetaxel after pembrolizumab treatment.
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Affiliation(s)
- Takashi Kawahara
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan (K.Y.); (T.T.); (J.-i.T.); (H.U.)
- Department of Urology, Graduate School of Medicine, Yokohama City University, Yokohama 236-0027, Japan; (K.U.); (H.I.); (H.H.); (K.M.)
| | - Akihito Hasizume
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan (K.Y.); (T.T.); (J.-i.T.); (H.U.)
| | - Koichi Uemura
- Department of Urology, Graduate School of Medicine, Yokohama City University, Yokohama 236-0027, Japan; (K.U.); (H.I.); (H.H.); (K.M.)
| | - Katsuya Yamaguchi
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan (K.Y.); (T.T.); (J.-i.T.); (H.U.)
| | - Hiroki Ito
- Department of Urology, Graduate School of Medicine, Yokohama City University, Yokohama 236-0027, Japan; (K.U.); (H.I.); (H.H.); (K.M.)
| | - Teppei Takeshima
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan (K.Y.); (T.T.); (J.-i.T.); (H.U.)
| | - Hisashi Hasumi
- Department of Urology, Graduate School of Medicine, Yokohama City University, Yokohama 236-0027, Japan; (K.U.); (H.I.); (H.H.); (K.M.)
| | - Jun-ichi Teranishi
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan (K.Y.); (T.T.); (J.-i.T.); (H.U.)
| | - Kimito Ousaka
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan (K.Y.); (T.T.); (J.-i.T.); (H.U.)
| | - Kazuhide Makiyama
- Department of Urology, Graduate School of Medicine, Yokohama City University, Yokohama 236-0027, Japan; (K.U.); (H.I.); (H.H.); (K.M.)
| | - Hiroji Uemura
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan (K.Y.); (T.T.); (J.-i.T.); (H.U.)
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15
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Nectin-4: a Tumor Cell Target and Status of Inhibitor Development. Curr Oncol Rep 2023; 25:181-188. [PMID: 36696077 DOI: 10.1007/s11912-023-01360-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW This study aims to gather the current state of the literature about anti-Nectin-4 innovative associations in solid tumors and to investigate underlying resistance mechanisms. RECENT FINDINGS Antibody-drug conjugate (ADC) targeting Nectin-4 efficacy gained attention and offers a promising association with other antineoplastic drugs especially in urothelial carcinoma. The heterogeneity of Nectin-4 expression across the molecular subtypes was highlighted especially in urothelial cancers. A unique study using preclinical models demonstrated an upregulation of P-gp expression, which may explain the anti-Nectin-4 resistance mechanisms. Further studies are urgently needed to understand anti-Nectin-4 sensitivity and resistance phenomenon. The growing therapeutic associations of enfortumab vedotin offer optimistic opportunities in management and treatment of wide range of solid tumors including rare aggressive malignancies.
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16
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Isoda B, Shiga M, Kandori S, Nagumo Y, Yoshino T, Ikeda A, Kawahara T, Kimura T, Negoro H, Hoshi A, Mathis BJ, Nishiyama H. Complete Response to Enfortumab Vedotin in a Hemodialysis Patient with Metastatic Urothelial Carcinoma: A Case Report. Case Rep Oncol 2023; 16:414-418. [PMID: 37384209 PMCID: PMC10294212 DOI: 10.1159/000530780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/11/2023] [Indexed: 06/30/2023] Open
Abstract
Enfortumab vedotin (EV) is an antibody-drug conjugate and a promising agent for metastatic urothelial carcinoma (mUC). However, evaluations in end-stage renal disease patients undergoing hemodialysis are unreported. Here, we report such a case. A 74-year-old woman with mUC, on hemodialysis for complete urinary tract extirpation, was diagnosed with multiple pulmonary metastases after treatment with gemcitabine-carboplatin followed by pembrolizumab. As third-line therapy, she received a standard dose of EV. She achieved complete response after 2 cycles without grade 3 or higher adverse events, demonstrating the utility of EV in this setting.
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Affiliation(s)
- Bunpei Isoda
- Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masanobu Shiga
- Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Shuya Kandori
- Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoshiyuki Nagumo
- Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takayuki Yoshino
- Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Atsushi Ikeda
- Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takashi Kawahara
- Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tomokazu Kimura
- Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiromitsu Negoro
- Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akio Hoshi
- Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Bryan J Mathis
- International Medical Center, University of Tsukuba Affiliated Hospital, Tsukuba, Ibaraki, Japan
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17
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Hanna KS. Advancements in Therapy for Bladder Cancer: Enfortumab Vedotin. J Adv Pract Oncol 2020; 11:412-417. [PMID: 33604101 PMCID: PMC7863123 DOI: 10.6004/jadpro.2020.11.4.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The treatment paradigm for urothelial carcinoma (UC), a common genitourinary cancer, has significantly expanded in recent years. Enfortumab vedotin, a Nectin-4-targeted antibody-drug conjugate, was recently approved by the U.S. Food & Drug Administration for patients with advanced or metastatic UC following chemotherapy and immunotherapy. Approval of enfortumab vedotin was based on findings from the EV-201 trial, which demonstrated objective response rates of 44%. Patients treated with enfortumab vedotin should be monitored for specific toxicities, including peripheral neuropathy, rash, and hyperglycemia. In this article, the clinical implications of enfortumab vedotin for the treatment of advanced UC are reviewed.
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