PhD Scientific Days 2024

Poster Session H - Theoretical and Translational Medicine 1.

Identifying patients who benefit from enfortumab vedotin in advanced urothelial carcinoma: Systematic Review and Meta-Analysis

Text of the abstract

Background:
Enfortumab vedotin (EV) has emerged as a promising therapeutic option for advanced urothelial carcinoma (aUC). However, despite encouraging study findings, significant knowledge gaps persist regarding optimal patient selection and real-world application of EV. Therefore, the aim of our study was to assess the clinical parameters for their association with the efficacy of EV.
Methods:
This systematic review and meta-analysis followed the PRISMA 2020 guideline and adhered to the Cochrane Handbook. We included studies involving patients with aUC treated with EV monotherapy. We evaluated various clinical parameters for their associations with objective response rate (ORR), overall survival (OS), and progression-free survival (PFS). We conducted a systematic search on November 16, 2023, in the Embase, PubMed, and Cochrane library databases and performed a selection of identified publications by two independent researcher. For ORR pooled event rates with 95% confidence intervals (CI), while for time-to-event (OS, PFS) analyses random effect Cox regression calculations were used.
Results:
Of the 1,680 identified publications 23 they proved eligible for systematic review and meta-analysis. Our results showed that EV is similarly effective in bladder UC as in upper tract UC. In addition, EV had higher response rates in those aUC patients who responded well to previous platinum (HR: 2.65, 95%CI: 1.04-6.72, p=0.046) or immune checkpoint inhibitor therapy (HR: 1.51, 95%CI: 1.12-2.04, p=0.017). Patients with unfavorable ECOG status were significantly associated with better OS (HR: 2.93, 95% CI: 1.64-5.22, p<0.001) and ORR (HR: 1.88, 95%CI: 1.27-2.80, p=0.006) as well as positive tissue PD-L1 status tended to be associated with lower EV efficacy.
Conclusion:
We have identified a series of parameters associated with differential EV treatment benefits. Patients with certain parameters (e.g. good response to previous chemo or immune therapies, favorable ECOG status) should be prioritized for EV therapy, while others may benefit more from other treatments.