Enfortumab vedotin

How it works

Its antibody component targets Nectin-4 on tumour cells and, after internalisation, releases the microtubule-disrupting agent monomethyl auristatin E (MMAE), which arrests the cell cycle and triggers apoptosis.

Prescribing in practice

• Serious and sometimes fatal cutaneous reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis can occur, so monitor closely for severe skin reactions and withhold or discontinue if they develop (MHRA/SPC warning).
• Hyperglycaemia, including diabetic ketoacidosis, can occur even in patients without diabetes; check blood glucose before and during treatment.
• Peripheral neuropathy and ocular disorders are common and may require dose modification or interruption.

Monitoring

Monitor skin, blood glucose, peripheral neurological function and eyes (with consideration of ophthalmic review) throughout treatment, alongside routine blood counts.

Counselling the patient

• Report any new or spreading rash, blistering or peeling skin urgently.
• Tell your team about increased thirst, frequent urination, tingling or numbness, or blurred vision.
• Attend all scheduled blood tests and eye checks.

Evidence & guidelines

Enfortumab vedotin is approved for advanced urothelial cancer on the basis of randomised trial data and is covered by NICE technology appraisal guidance.