Pembrolizumab with enfortumab vedotin for untreated metastatic urothelial cancer [ID6332]

Urothelial carcinoma is cancer of the transitional cells which form the inner lining of the bladder urethra ureter or renal pelvis.

Urothelial carcinoma accounts for approximately 90% of bladder cancers.1* Urothelial cancer can also originate in the upper urinary tract.

Urothelial carcinomas can be described as non-invasive or invasive depending on how far the carcinomas invade the tissues. Non invasive urothelial carcinomas can be further split into papillary carcinomas or flat carcinomas.

Papillary carcinomas often grow towards the hollow part of the organ (for example bladder and ureter) without going into deeper layers. Flat carcinomas remain in the inner layers.

Both papillary and flat carcinomas can become invasive.In 2020 16547 new bladder cancers were diagnosed in England.2 Bladder cancer is the 11th most common cancer in the UK.34 The majority of cases are in those over the age of 75 but can also affect young people too and is more common in men than women with incidences of 22.8 and 8.3 per 100000 respectively.3*4* Smoking is a major factor in the cause of bladder cancer.People with urothelial carcinoma may receive treatment with surgery and/or radiotherapy.

Treatment may be given before (neoadjuvant) or after surgery and/or radiotherapy in an attempt to improve cure rates.

If the cancer is too advanced for surgery/radiotherapy treatments can be used to improve quality of life and survival.The first-line treatment options for locally advanced or metastatic urothelial carcinoma in adults include a cisplatin-based chemotherapy regimens or carboplatin in combination with gemcitabine if a cisplatin-based chemotherapy regimen is unsuitable.

Methotrexate vinblastine doxorubicin and cisplatin [MVAC] in combination with granulocyte-colony stimulating factor [G-CSF] may also be used.

Atezolizumab is also an option if a cisplatin-based chemotherapy regimen is unsuitable and tumours express PD-L1 at a level of 5% or more.References*1. Cancer Research UK (2023) Types of bladder cancer. Accessed October 20232. National Disease Registration Service (2023) Bladder cancer statistics Get Data Out programme.

Accessed March 20243. NHS Digital (2022) Cancer Registration Statistics England 2020. Accessed October 20234. Patient (2021) Bladder Cancer -Diagnosis Symptoms and Treatment. Accessed October 2023