Examining Discontinuation Outcomes of EV in Metastatic Urothelial Carcinoma

Select patients being treated with enfortumab vedotin-ejfv (EV; Padcev) for metastatic urothelial carcinoma may have the potential to safely discontinue treatment and remain treatment-free even after 1 year, according to Joy Li, MD.

In a conversation with CancerNetwork® at the 2026 American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium, Li, a medical oncologist at the Fox Chase Cancer Center of Temple University, discussed findings from a retrospective analysis of patients treated with enfortumab vedotin with or without pembrolizumab (Keytruda) in the adjuvant setting for at least 2 cycles of treatment.

She explained that 57% of patients who discontinued in either group were alive and treatment-free after 1 year, which may suggest that responses can be maintained, even in the absence of ongoing treatment. Next, Li highlighted key considerations for safe discontinuation of the drug, including updated discontinuation guidelines on when to stop and who can stop, as well as which clinical criteria would help identify optimal candidates for early discontinuation.

Transcript:

We found that patients who discontinued EV due to good response or toxicity still had good durable responses. A year after discontinuing, 57% of patients were still alive and treatment-free. This…has strong clinical implications because when we have these shared decision-making [discussions] with the patient about discontinuing treatment because of good response or toxicity, we can sometimes be more confident that they’re still going to have a good response for a long time, up to a year.

The next question is, can we have more guidelines on when to stop? Right now, the guidelines [recommend] to continue until toxicity or progression, but can we be more deliberate with stopping? The next question is, can we create more specific guidelines on [determining] who can stop? Are there certain clinical criteria, such as imaging or, in the future, ctDNA––things like that––to help us judge who is a good candidate for stopping early?

Reference

Li J, Fredette J, Dhanikonda N, et al. Clinical outcomes of metastatic urothelial carcinoma patients discontinuing enfortumab vedotin due to toxicity and/or clinical response. J Clin Oncol. 2026;44(suppl 7):719. doi:10.1200/JCO.2026.44.7_suppl.719