Original Investigation

First-Line Enfortumab Vedotin Plus Pembrolizumab vs Gemcitabine Plus Cisplatin for Metastatic Urothelial Carcinoma

JAMA Network Open 10.1001/jamanetworkopen.2026.21032

July 01, 2026 at 11:00 AM EDT

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Is first-line enfortumab vedotin plus pembrolizumab (EV/P) associated with improved clinical outcomes compared with gemcitabine plus cisplatin (G/C) in patients with metastatic urothelial carcinoma in a multicenter retrospective cohort study?In this cohort study of 4433 patients, first-line EV/P was associated with significantly longer overall survival, lower risk of early hospitalization, and longer time to next treatment compared with G/C. EV/P had a distinct adverse event profile, with fewer hematologic and gastrointestinal toxic effects but more immune-related adverse effects.In this cohort study, EV/P appeared to be an effective and tolerable first-line therapy for metastatic urothelial carcinoma in routine clinical practice.

Corresponding Author: Raj Satkunasivam, MD, MS, Department of Urology, Houston Methodist Hospital, 6560 Fannin St, Ste 2100, Houston, TX 77030 (raj.satkunasivam@gmail.com).

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