FDA approves new type of therapy to treat advanced urothelial cancer

Today, the U.S. Food and Drug Administration
granted accelerated approval to Padcev (enfortumab vedotin-ejfv), a
Nectin-4-directed antibody and microtubule inhibitor conjugate, meaning the
drug specifically targets cancer cells – in this case, the cell adhesion
molecule Nectin-4, which is highly expressed in urothelial cancers. Padcev is
indicated for the treatment of adult patients with locally advanced (when
cancer has grown too large to be surgically removed) or metastatic (when cancer
cells spread to other parts of the body) urothelial cancer who have previously
received a programmed death receptor-1 (PD-1) or programmed death ligand 1
(PD-L1) inhibitor and a platinum-containing chemotherapy. Platinum-containing
chemotherapy, PD-1 and PD-L1 inhibitors are standard treatments for patients
with bladder cancer, the sixth most common cancer in the U.S. Urothelial cancer,
accounting for more than 90% of bladder cancers, begins in cells that line the
bladder and nearby organs. Padcev represents a new type of therapy for patients
with advanced urothelial cancer whose disease has progressed on chemotherapy
and immunotherapy.

“Antibody-drug conjugates are strategic tools
in the targeted treatment of cancer. These conjugates combine the ability of
monoclonal antibodies to target specific receptors on cancer cells and then
deliver a drug to the cancer cell,” said Richard Pazdur, M.D., director of the
FDA’s Oncology Center of Excellence and acting director of the Office of
Oncologic Diseases in the FDA’s Center for Drug Evaluation and Research.
“Padcev is an antibody-drug conjugate that targets Nectin-4, a cell surface protein
expressed on bladder cancer cells and a cell-killing agent, monomethyl
auristantin E.”

Padcev was approved based on the results of a
clinical trial that enrolled 125 patients with locally advanced or metastatic
urothelial cancer who received prior treatment with a PD-1 or PD-L1 inhibitor
and platinum-based chemotherapy. The overall response rate, reflecting the
percentage of patients who had a certain amount of tumor shrinkage, was 44%,
with 12% having a complete response and 32% having a partial response. The
median duration of response was 7.6 months.

The most common side effects for patients taking Padcev were fatigue, peripheral neuropathy (nerve damage resulting in tingling or numbness), decreased appetite, rash, alopecia (hair loss), nausea, altered taste, diarrhea, dry eye, pruritis (itching) and dry skin. Patients may experience hyperglycemia (high blood sugar levels) regardless of whether they have diabetes or not, and blood sugar levels should be monitored closely in patients receiving Padcev. Patients should also be monitored for new or worsening peripheral neuropathy and have the dose of Padcev interrupted, reduced or discontinued if needed. Patients may experience eye disorders, including dry eyes and vision changes, while taking Padcev. Health care professionals may consider prophylactic artificial tears for dry eyes and referral to an ophthalmologist for any new symptoms related to the eye. Patients who experience infusion site extravasation (leakage of medications administered through veins into the surrounding tissue) may experience delayed extravasation site reactions with pain, blisters and peeling of skin. Adequate venous access should be ensured prior to starting Padcev.

Reference: https://www.fda.gov/news-events/press-announcements/fda-approves-new-type-therapy-treat-advanced-urothelial-cancer

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