Enfortumab vedotin
ADCs
Antibody-drug conjugates (ADCs)High alert
An error with this medicine can cause serious harm: double checks and protocols are used.
Anti-Nectin-4 antibody carrying MMAE, for advanced urothelial (bladder) cancer, often with pembrolizumab. Watch skin, blood sugar, nerves and eyes.
Quick facts
- Group
- Antibody-drug conjugates (ADCs)
- Target
- Nectin-4, a cell adhesion protein on urothelial cancer cells
- Used for
- Locally advanced
- Key effects
- Fatigue · Hair loss · Peripheral neuropathy
- Monitor
- Skin at every visit · Blood glucose before each dose
- ATC
- L01FX13
No doses: the clinician sets them by the current guideline.
Mechanism of action
The fully human antibody binds Nectin-4, an adhesion molecule highly expressed in urothelial carcinoma. The conjugate is internalised and releases monomethyl auristatin E (MMAE), which disrupts microtubules, stops mitosis and kills the cell.
- The antibody binds Nectin-4 on the urothelial cancer cell
- The conjugate enters the cell
- MMAE is released and disrupts microtubules
- Mitotic arrest and cell death
Indications
- Locally advanced or metastatic urothelial cancer: with pembrolizumab, or alone after platinum chemotherapy and immunotherapy or when cisplatin cannot be used. Bladder cancer →
Adverse effects
Common
- Fatigue, decreased appetite, weight loss
- Hair loss, dry skin, rash
- Peripheral neuropathy
- Taste changes, nausea, diarrhoea
- Dry eyes
Contraindications
- Allergy to the drug
- Caution in diabetes or high blood glucose, pre-existing neuropathy and liver disease
Key interactions
- Strong CYP3A4 inhibitors
- May raise MMAE exposure and its toxicity.
- Pembrolizumab (combination use)
- Used together on purpose; skin and lung reactions are watched for both drugs.
What is monitored
- Skin at every visit, especially in the first cycles
- Blood glucose before each dose
- Neuropathy symptoms
- Eye symptoms and dry eyes
- Breathing symptoms (pneumonitis)
- Liver tests
Administration and safety
- Intravenous infusion only; the infusion site is watched for skin reactions.
- Hazardous drug: prepared and handled with chemotherapy precautions.
- Artificial tears may be recommended to prevent dry eyes.
Pregnancy and breastfeeding
Can harm the fetus; effective contraception is used during and after treatment, and breastfeeding is avoided.
Nursing care
- Inspect the skin and mouth before each dose; report rash, blisters or sores.
- Check blood glucose; report thirst, frequent urination or blurred vision.
- Ask about numbness or weakness in the hands and feet, and about eye pain or vision changes.
- Teaching: report any new rash early, use effective contraception, avoid breastfeeding.
Pharmacokinetics
- Absorption
- Intravenous infusion in cycles.
- Metabolism
- The released MMAE is metabolised mainly by CYP3A4.
Test yourself
Think of the answer, then tap the question to see it.
Which antigen does enfortumab vedotin bind?
Nectin-4, an adhesion protein highly expressed in urothelial cancer.
What is the boxed warning of enfortumab vedotin?
Serious, potentially fatal skin reactions.
Which metabolic problem can enfortumab vedotin cause even in people without diabetes?
Hyperglycaemia, which can progress to diabetic ketoacidosis.
Connections
← Back to the class: Antibody-drug conjugates (ADCs)
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Enfortumab vedotin-ejfv Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); Enfortumab Vedotin-ejfv - NCI (National Cancer Institute, 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.