P2, N=58, Recruiting, Peking University Third Hospital

We describe a 57-year-old man receiving EV and pembrolizumab who developed profound insulin-resistant DKA that persisted despite standard therapy. Following initiation of induction alongside continued insulin therapy, resolution of ketoacidosis occurred within 46 hours. This case illustrates a pharmacokinetic-informed approach to EV-associated refractory DKA and highlights how understanding drug metabolism may improve therapeutic outcomes when conventional therapy is insufficient.

P2, N=39, Not yet recruiting, University of Florida

P2, N=132, Not yet recruiting, Akeso

P2, N=28, Recruiting, Mayo Clinic | Trial completion date: Nov 2026 --> Jun 2028 | Trial primary completion date: Nov 2026 --> Jun 2028

A 64-year-old man with metachronous metastatic urothelial carcinoma originating from the right renal pelvis underwent nectin-4-targeted [68Ga]Ga-NECT-224 PET/CT prior to initiation of nectin-4-targeted antibody-drug conjugate (ADC) therapy with enfortumab-vedotin (PADCEV), in combination with pembrolizumab. Subsequent [68Ga]Ga-NECT-224 PET/CT restaging revealed multiple new lesions with intense nectin-4 expression. This case illustrates the potential of [68Ga]Ga-NECT-224 PET/CT to visualize heterogeneous nectin-4 expression, its potential in therapy guidance, and highlights the need for theranostic strategies in patients retaining target expression despite cytotoxic therapy resistance.

P=N/A, N=40, Not yet recruiting, University of Florence

P1/2, N=6, Not yet recruiting, Pfizer Inc.

P1, N=40, Not yet recruiting, Samsung Bioepis Co. Ltd.

PBC is often considered as a subsequent treatment after EVP therapy, except in patients with FGFR gene alterations. PBC followed by avelumab maintenance therapy may represent a feasible subsequent treatment option for selected patients with mUC who achieve disease control after EVP therapy.

Enfortumab vedotin (NECTIN4-ADC), a NECTIN4-targeting antibody-drug conjugate, has shown substantial efficacy in urothelial carcinoma, yet primary and acquired resistance remain major barriers to durable benefit...Pharmacologic inhibition of AKR1C1 restores ADC uptake, increases payload delivery, and enhances therapeutic sensitivity in preclinical models. Together, these findings define a clinically relevant target-high but uptake-defective resistance state and establish altered membrane trafficking as a therapeutic target for overcoming ADC therapy failure in cancer.

In this carefully selected elderly MIBC patient, neoadjuvant enfortumab vedotin combined with toripalimab was well tolerated and associated with marked tumor regression and a favorable pathological response on post-treatment TURBT. Bladder preservation was attempted, illustrating the feasibility of this regimen and generating a hypothesis for future investigation.