Would you consider a treatment break for a patient with metastatic urothelial carcinoma who achieved a near-complete response to enfortumab?

The answer to this question is highly dependent on the specific clinical context. However, for a patient who has a deep and durable response to enfortumab vedotin monotherapy and has been on treatment for a prolonged period of time (again context-dependent, but at least a few months), I think it is reasonable to pause treatment. In particular, this helps offset the development of severe toxicities likely neuropathy. I often consider ctDNA results in this situation to support this decision. Once ...

Reasonable points by Dr. @Dr. First Last. The major challenge is the lack of prospective data (we need trials to assess de-escalation questions with EV alone or EV/pembro). Until then, my approach depends on the clinical context (as Dr. Koshkin) wrote, esp. toxicity, with dose adjustments as needed. The data presented by Dr. @Dr. First Last at the ASCO’24 meeting were very helpful to discuss with patients and consider the optimal initial dose & dose adjustments as needed based on side effects.

T...