This modeling study compared first-line enfortumab vedotin + pembrolizumab (EV+P, from EV-302) versus platinum-based chemotherapy ± avelumab maintenance (from JAVELIN Bladder-100) in locally advanced/metastatic urothelial carcinoma (la/mUC), using a hybrid approach that applied JB-100 avelumab hazard ratios to EV-302 PBC patients without progression.
EV+P significantly improved both PFS (HR 0.51, 95% CI 0.44–0.59) and OS (HR 0.64, 95% CI 0.49–0.86) versus the modeled PBC ± avelumab arm, with results consistent across sensitivity analyses.
- The model assumes **all** patients without progression received avelumab, which likely overestimates real-world avelumab uptake and may favor the PBC arm. - Comparison relies on cross-trial modeling (patient-level EV-302 data combined with study-level JB-100 data), not a head-to-head RCT. - Avelumab was approved after EV-302 initiation, so its use in that trial was potentially underrepresented.
EV+P offers meaningful PFS and OS gains over platinum-based chemotherapy even when avelumab maintenance is assumed for all eligible patients, supporting EV+P as the preferred first-line standard of care in la/mUC. Clinicians choosing between these regimens need not wait to see if patients respond to chemotherapy before acting on this evidence.
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