This multi-institutional retrospective cohort study evaluated whether enfortumab vedotin (EV)-induced cutaneous adverse events (cAEs) are independently associated with survival in 449 patients with locally advanced or metastatic urothelial carcinoma treated with EV between 2020 and 2025, while accounting for immortal time bias and concurrent immune checkpoint inhibitor (ICI) exposure.
45.9% of patients developed a cAE; 61.7% were attributed to EV. EV-induced cAEs were independently associated with improved progression-free survival (HR 0.60, 95% CI 0.43–0.82) and overall survival (HR 0.46, 95% CI 0.31–0.67) at the 30-day landmark. Early-onset cAEs were protective at all landmark times; high-grade cAEs were not associated with worse survival.
- Retrospective design with manual chart extraction introduces potential selection and ascertainment bias. - Likelihood scoring to attribute cAEs to EV vs. other causes (e.g., ICIs) is not a validated tool and may misclassify events. - Full text is under embargo; some methodological details could not be fully verified from the abstract alone.
Clinicians should recognize that EV-induced skin reactions — including pruritus, desquamating dermatitis, and morbilliform rash — may signal better treatment response rather than a reason to stop therapy. High-grade cAEs did not worsen survival, supporting careful management over reflexive dose reduction or discontinuation.
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