Oncology Today with Dr Neil Love Metastatic Bladder Cancer — Rapid Case Review Issue 3
Mar 27, 2026
Dr Jacqueline T Brown, urologic medical oncologist who presents real metastatic urothelial bladder cancer cases. Dr Matthew Milowsky, medical oncologist who interprets clinical evidence and management strategies. They discuss enfortumab vedotin plus pembrolizumab use and duration, managing neuropathy and dose adjustments, brain metastases and local versus systemic approaches, ctDNA, FGFR3/HER2 biomarkers, and sequencing targeted therapies.
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Longer Survival Reveals New Metastatic Patterns
- As systemic therapies extend survival, clinicians are seeing more atypical metastatic sites like brain involvement in urothelial carcinoma.
- Matthew Milowsky noted historical parallels where better systemic control revealed new patterns such as brain and cutaneous metastases.
EV Pembrolizumab Produces Durable Responses
- EV plus pembrolizumab shows unprecedented durable outcomes with five-year survival signals suggesting possible cures for a subset.
- Milowsky referenced EV-103 five-year data with about 41% survival, highlighting ctDNA as a potential selector for long-term responders.
Use ctDNA To Guide Consolidation Decisions
- Use circulating tumor DNA (ctDNA) when considering consolidative procedures or treatment holds in metastatic urothelial carcinoma.
- Milowsky routinely sends ctDNA for cases like colostomy reversal or consolidation, but remains cautious with prior brain metastases.