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A Phase I Study of Enfortumab Vedotin in Japanese Patients with Locally Advanced or Metastatic Urothelial Carcinoma

Locally advanced or metastatic urothelial cancer is an aggressive form of cancer with high recurrence rates and low survival. Nectin-4 is a cell adhesion molecule commonly expressed in several tumors, including high expression in urothelial cancer. Enfortumab vedotin is an antibody–drug conjugate composed of an anti-Nectin-4 humanized monoclonal antibody linked to the microtubule disrupting agent, monomethyl auristatin E.

In this phase I study (NCT03070990), Japanese patients with locally advanced/metastatic urothelial cancer treated with prior chemotherapy, or ineligible for cisplatin, were randomized 1:1 to receive 1.0 mg/kg (Arm A) or 1.25 mg/kg (Arm B) enfortumab vedotin on Days 1, 8, and 15 of each 28-day cycle. Assessing the pharmacokinetic and safety/tolerability profiles of enfortumab vedotin were primary objectives; investigator-assessed antitumor activity (RECIST v1.1) was a secondary objective. Seventeen patients (n = 9, Arm A; n = 8, Arm B) received treatment. Pharmacokinetic data suggest a dose-dependent increase in enfortumab vedotin maximum concentration and area under the concentration–time curve at Day 7.

Enfortumab vedotin was well tolerated across both doses. Dysgeusia and alopecia (n = 9 each) were the most common treatment-related adverse events. Regardless of attribution, grade ≥ 3 adverse events occurring in ≥2 patients were anemia and hypertension (n = 2 each). One patient achieved a confirmed complete response (Arm A) and five achieved confirmed partial responses (n = 3, Arm A; n = 2, Arm B). Objective response and disease control rates were 35.3% and 76.5%, respectively. In Japanese patients with locally advanced/metastatic urothelial cancer, enfortumab vedotin is well tolerated with preliminary antitumor activity and a pharmacokinetic profile consistent with prior reports.

Shunji Takahashi1 & Motohide Uemura2 & Tomokazu Kimura3 & Yoshihide Kawasaki4 & Atsushi Takamoto5 & Akito Yamaguchi6 & Amal Melhem-Bertrandt7 & Elaina M. Gartner8 & Takashi Inoue9 & Rio Akazawa9 & Takeshi Kadokura9 & Toshiki Tanikawa10

  1. Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
  2. Osaka University Hospital, Osaka, Japan
  3. University of Tsukuba Hospital, Tsukuba, Japan
  4. Tohoku University Hospital, Sendai, Japan
  5. Okayama University Hospital, Okayama, Japan
  6. Harasanshin Hospital, Fukuoka, Japan
  7. Astellas Pharma Global Development, Northbrook, IL, USA
  8. Seattle Genetics, Seattle, WA, USA
  9. Astellas Pharma, Inc., Tokyo, Japan
  10. Niigata Cancer Center Hospital, Niigata, Japan