Bladder, kidney, and other urologic cancers:
Indications for: PADCEV
As a single agent to treat locally advanced or metastatic urothelial cancer in adults who have previously received a programmed death receptor-1 (PD-1) or programmed death-ligand 1 (PD-L1) inhibitor and platinum-containing chemotherapy, or are ineligible for cisplatin-containing chemotherapy and have previously received ≥1 prior lines of therapy. In combination with pembrolizumab to treat locally advanced or metastatic urothelial cancer in adults who are not eligible for cisplatin-containing chemotherapy.
Give by IV infusion over 30min. As a single agent: 1.25mg/kg (max 125mg for patients ≥100kg) on Days 1, 8 and 15 of a 28-day cycle; continue until disease progression or unacceptable toxicity. In combination with pembrolizumab: 1.25mg/kg (max 125mg for patients ≥100kg) on Days 1 and 8 of a 21-day cycle; continue until disease progression or unacceptable toxicity. Dose modifications: see full labeling.
Serious skin reactions.
Severe cutaneous reactions (including SJS, TEN); monitor closely. Consider withholding for persistent or recurrent Grade 2 skin reactions until Grade ≤1. Withhold, consult a specialist to confirm for suspected SJS, TEN or for Grade 3 reactions; permanently discontinue if confirmed SJS or TEN, Grade 4 or recurrent Grade 3 reactions occur. Monitor blood glucose levels in patients with, or at risk of, diabetes or hyperglycemia; withhold dose if blood glucose >250mg/dL. Monitor for pneumonitis/ILD; withhold if Grade 2 reaction occurs and consider dose reduction; permanently discontinue if Grade 3 or 4 reaction. Monitor for new or worsening symptoms of peripheral neuropathy; consider dose interruption/reduction if occurs; permanently discontinue if Grade ≥3 reaction. Monitor for ocular disorders; if symptoms occur, consider ophthalmologic exam; interrupt/reduce dose if needed. Monitor for infusion site extravasation. Moderate or severe hepatic impairment (total bilirubin >1.5×ULN and any AST): avoid. Embryo-fetal toxicity. Advise to use effective contraception during and for 2 months (females) and for 4 months (males w. female partners) after the last dose. Pregnancy: exclude status prior to initiation. Nursing mothers: not recommended (during and for ≥3 weeks after the last dose).
Nectin-4 directed antibody-drug conjugate.
May be potentiated by dual P-gp and strong CYP3A4 inhibitors (eg, ketoconazole); monitor closely. May be antagonized by dual P-gp and strong CYP3A4 inducers (eg, rifampin).
Fatigue, peripheral neuropathy, decreased appetite, rash, alopecia, nausea, dysgeusia, diarrhea, dry eye, pruritus, decreased weight, dry skin, anemia, lab abnormalities (increased AST/ALT, increased glucose, increased creatinine, decreased lymphocytes, decreased hemoglobin, decreased neutrophils, decreased platelets, decreased phosphate, decreased albumin, decreased sodium, increased urate, increased lipase). In combination with pembrolizumab: also constipation, peripheral edema, dry eye, dizziness, arthralgia, urinary tract infection, lab abnormalities (decreased/increased potassium, increased calcium).
Half-life: 3.6 days (for ADC); 2.6 days (for unconjugated MMAE).
Mean clearance: 0.11 L/h (for enfortumab vedotin-ejfv); 2.11 L/h (for unconjugated MMAE).
Fecal (17%), renal (6%).
Generic Drug Availability: