GU Cancers 2026 | Improving first-line urothelial carcinoma care in community practice
Daniel Petrylak, MD, Yale University, New Haven, CT, discussed a quality improvement initiative addressing gaps in evidence-based first-line care for locally advanced or metastatic urothelial carcinoma in community oncology settings serving underserved populations. Despite enfortumab vedotin and pembrolizumab being the standard of care with the exception of a few cases, a number of physicians are not prescribing this combination, highlighting the need for further education. This interview took place at the 2026 ASCO GU Cancers Symposium in San Francisco, CA.
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Transcript
So we polled 15 practices, and this was more than 150 patients looking at what the primary treatment was for their bladder cancer. And about a third of patients did not receive EV-Pembro and enfortumab and pembrolizumab as a first-line therapy. And so the question is, why did they not receive that? Is it because of patient selection? Is it because of physician selection? Really, if you look at the criteria for EV-Pembro, most patients should receive it...
So we polled 15 practices, and this was more than 150 patients looking at what the primary treatment was for their bladder cancer. And about a third of patients did not receive EV-Pembro and enfortumab and pembrolizumab as a first-line therapy. And so the question is, why did they not receive that? Is it because of patient selection? Is it because of physician selection? Really, if you look at the criteria for EV-Pembro, most patients should receive it. The only ones in my mind who should not receive it are those who have autoimmune disorders and can’t get the pembrolizumab, and perhaps neuropathy, and they can’t get the enfortumab. So what this indicates to us is that you need a very, very strong physician education program to make sure that these patients receive the maximal treatment up front. So that’s what the purpose of this abstract did. In fact, what I was even surprised to see is that 10% of patients were getting checkpoint only as first-line therapy.
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