(UroToday.com) Once patients with advanced urothelial cancer progress through platinum chemotherapy and anti-PD-1 axis immunotherapy, treatment options are limited. Enfortumab vedotin is an antibody-drug conjugate directed against the Nectin-4 protein, which is expressed at high levels on the surface of many types of cancers including urothelial cancers, and delivers the microtubule-disrupting cytotoxic agent monomethyl auristatin E (MMAE) to cells expressing this protein. The phase 1 trial of this molecule (EV-101) in patients with urothelial cancers who had received platinum and immunotherapy demonstrated a response in almost half of patients treated. The phase 2 trial of enfortumab vedotin, (EV-201), was designed for two cohorts as shown below.