Metastatic urothelial carcinoma (mUC) is an aggressive malignancy with a poor prognosis. Current treatment guidelines recommend chemotherapy as the first-line therapy for eligible patients, but immune checkpoint inhibitors and antibody-drug conjugates have shown promising results. Enfortumab vedotin and pembrolizumab (EV+P) is a novel combination therapy demonstrating significant efficacy in clinical trials compared to standard chemotherapy. TriNetX, a global health research network, enables real-world evidence generation through large-scale, de-identified patient data.

This study utilized the TriNetX platform to perform a retrospective analysis comparing two cohorts of patients diagnosed with mUC. Cohort 1 included patients receiving EV+P, while Cohort 2 included those treated with cisplatin-based chemotherapy. Kaplan-Meier analysis was used to evaluate overall survival (OS) between the two groups, and propensity score matching was performed to minimize selection bias.

After matching, 485 patients were included in each cohort. The Kaplan-Meier analysis revealed a statistically significant improvement in OS for the EV+P group compared to the chemotherapy group. The median survival days in EV+P group is 771 days, and 517 days in chemotherapy group with a p-value of 0.0035.

The results demonstrate a significant survival advantage of EV+P over chemotherapy in mUC patients in real world data, aligning with clinical trial findings. This study supports the use of EV+P as an effective treatment option in real-world settings, highlighting the importance of novel therapies in managing advanced mUC.