Enfortumab vedotin + pembrolizumab across the bladder cancer continuum

Enfortumab vedotin, a Nectin-4-directed antibody-drug conjugate, combined with pembrolizumab is the first regimen to displace platinum chemotherapy at every stage of a common solid tumour, bladder and urothelial cancer. Nectin-4 is expressed on almost all urothelial cancers, and the MMAE payload induces immunogenic cell death and dendritic-cell maturation that the PD-1 antibody then exploits. Three positive phase 3 trials underpin it: EV-302 / KEYNOTE-A39 in metastatic disease, where survival improved substantially over chemotherapy, EV-303 / KEYNOTE-905 in cisplatin-ineligible muscle-invasive disease, approved in November 2025, and EV-304 / KEYNOTE-B15 in cisplatin-eligible disease, positive in December 2025. The pairing now serves fit and unfit patients alike.