Laura Wood on the Integration of Avelumab, Erdafitinib, and Enfortumab Vedotin into Urothelial Cancer Care

Laura Wood discusses the successful integration of avelumab, erdafitinib, and enfortumab vedotin-ejfv into oncology nursing practice.

Avelumab (Bavenzio), erdafitinib (Balversa), and enfortumab vedotin-ejfv (Padcev) are 3 distinctly different drugs which have recently been added to the fold of available urothelial cancer therapies, explains Laura Wood, RN, MSN, OCN.

Wood recently presented on novel approaches to urothelial cancer as part of the 6th Annual School of Nursing Oncology™ Meeting. In a recap interview with Oncology Nursing News®, she details nurse-specific considerations of these 3 agents.

“We [have] several new treatment options,” Wood says.“No. 1 is avelumab—which is approved as a maintenance therapy. It’s the first and only maintenance therapy approved for individuals with advanced or metastatic urothelial cancer that [has] not progressed with frontline platinum containing chemotherapy. Nurses need to be aware that this treatment is available, that it is an approved option for patients who are doing well and benefiting from first line platinum-based chemotherapy.”

In addition, nurses should know that patients will require premedication for the first 4 doses of avelumab, which is unique to the other approved immune checkpoint inhibitors, she adds.

“The second drug that I talked about was erdafitinib, and that is approved for locally advanced or metastatic urothelial cancer where there's an FTR3 or FGR2 genetic mutation,” she tells Oncology Nursing News®.

This means biomarker testing is necessary, she says. Further, the drug is linked to an increased risk of elevated phosphorous levels. Nurses should be cognizant of this and educate patients about this potential adverse event (AE)—and potentially educating them about a low phosphorus diet as well.

The drug also has a unique dosing titration. “We start that drug at 8 mg once daily, which is [two] 4-mg tablets. If patients, after 14 to 21 days, do not have increase in their phosphorus levels, or other significant grade to AEs including ocular AEs, that dose can be increased to 9 mg, which is a 3-mg tablet, and 3 tablets taken once daily.”

Educating the patient about the unique dosing regimen is important, she says.

Finally, Wood highlights enfortumab vedotin. The drug’s recommended dose is 1.25 mg/kg.1 The maximum dose is 125 mg/kg. It is administered intravenously over 30 minutes on days 1, 8, and 15, as part of a 28-day cycle.

“It is an antibody-drug conjugate that targets nectin-4 on the cell surface of your affiliate cancer cells,” Wood explains. “The drug binds to the Nectin-4, is taken into the cell where the linker of the drug and the drug conjugate is dissolved, [then] the microtubule payload is released and that leads to cancer cell apoptosis and death.”

Enfortumab vedotin may induce severe and fatal cutaneous AEs, including Stevens-Johnson syndrome and toxic epidermal necrolysis. These reactions frequently occur throughout the first treatment cycle but may also occur later.

Reference

Wood L. Novel approaches to renal and urothelial cancers. Presented at: 6th Annual School of Nursing Oncology™; July 29-30, 2022; San Diego, CA.