Study Ranks Metastatic Urothelial Carcinoma Treatments

Enfortumab vedotin ranks first in efficacy among 6 treatments for metastatic urothelial cancer, according to a recent analysis.

Andrea Messori, PharmD, of the Health Technology Assessment Unit and the University of Florence in Italy, and colleagues conducted the research and published their findings in Cureus.

Researchers used the Shiny method to assess the benefits of enfortumab vedotin and compare its efficacy with 5 previously developed treatments for metastatic urothelial cancer.

“This paper presents a preliminary experience based on the ‘one-to-many’ approach of the Shiny method. Numerous (or ‘many’) treatments for advanced or metastatic urothelial carcinoma have recently been reviewed. More recently, ‘one’ potentially innovative treatment has been made available,” the researchers wrote. “Our analysis was aimed at assessing the benefits of the new treatment in comparison with the alternatives developed previously.”

They used the Shiny method to reconstruct patient-level survival data to compare the Kaplan-Meier curves of 5 previously available treatments—pembrolizumab, nivolumab, atezolizumab, vinflunine, and standard chemotherapy—with “the potentially innovative agent represented by enfortumab vedotin,” the authors wrote.

Enfortumab vedotin was ranked first in efficacy, while immune checkpoint inhibitors were ranked second, with standard chemotherapy and vinflunine being “the least effective,” according to the authors.

In head-to-head indirect comparisons, patients treated with enfortumab vedotin had significantly better outcomes than patients treated with chemotherapy (hazard ratio [HR], 0.6645; 95% CI, 0.5571-0.7926; P<.001) and patients treated with immune checkpoint inhibitors (HR, 0.748; 95% CI, 0.608 to 0.921; P=.0062).

“The remarkable survival results of enfortumab were, to some extent, influenced by the slightly better prognosis of the population enrolled in the enfortumab trial in comparison with patients enrolled in the 3 [immune checkpoint inhibitor] trials,” the researchers wrote.

Immune checkpoint inhibitors performed significantly better than chemotherapy (HR, 0.8882; 95% CI, 0.7950-0.9923; P=.0361), while chemotherapy performed significantly better than vinflunine (HR, 1.2019; 95% CI, 1.0279-1.4053; P=.0212).

“The experience described herein shows that, when a potential innovative treatment (enfortumab vedotin) is developed in an already investigated area (metastatic urothelial cancer), the Shiny method can be applied according to the ‘one-to-many’ approach,” the authors concluded. “This allows us to quickly assess the place in therapy of the new treatment (the ‘one’) and to evaluate whether the new treatment determines a relevant incremental benefit in comparison with previous treatments (the ‘many’).”

Reference

The “One-to-Many” Survival Analysis to Evaluate a New Treatment in Comparison With Therapeutic Alternatives Based on Reconstructed Patient Data: Enfortumab Vedotin Versus Standard of Care in Advanced or Metastatic Urothelial Carcinoma