EV-related-cutaneous events (EVCEs) are among the most common side effects and can require dose modifications.1,2 Clinical presentations and recognition of dermatologic conditions, including medication side effects, often vary with race, and Black patients are frequently underrepresented in landmark oncology trials.3
In a recently published manuscript in Clinical Genitourinary Cancer, our team investigated differences in EVCE frequency between Black and White patients in two retrospective cohorts of EV-treated patients, an institutional cohort of patients seen at the Johns Hopkins Hospital (JH) and a national cohort of patients in the Flatiron Health (FH) deidentified electronic health record-derived database.
Seventy patients were identified in the JH cohort including 12 Black patients (17.1%). The FH cohort included 316 patients with 24 (7.6%) Black patients. In both cohorts, the frequency of EVCEs among Black patients was numerically higher compared to White patients (JH Cohort: 66.7% vs. 33.3%; FH Cohort: 25.0% vs. 15.8%), but the odds ratios (OR) of EVCE for Black vs. White patients were not statistically significant (OR in JH Cohort: 1.63 [95%CI: 0.44, 6.0]; OR in FH Cohort: 1.78 [95% CI: 0.67, 4.73]).
We also assessed the frequency of EVCEs among those receiving prior immunotherapy in the larger FH cohort. The proportion of Black patients with an EVCE was 25.0% (6/24 patients), 35.7% for those treated with P prior to EV (5/14 patients), and 55.6% when P was administered within 90 days before EV (5/ 9 patients) (Figure 1). Among those treated with prior P and prior P within 90 days before EV, the odds of EVCE were statistically significantly greater in Black compared to White patients.
As the use of EV is expanding, gaining a better understanding of EV-related side effects including EVCEs is crucial. Despite its small size, this hypothesis-generating study represents the largest cohort of EV-treated Black patients reported to date, including clinical trials. Our results highlight the importance of minority inclusion in trials to guide decision-making for diverse real-world populations and ensure equitable care. Our work also seeks to raise awareness for the early recognition and optimal management of EVCEs in patients of different races. This work is not meant to diminish the use of EV+P; rather, we feel that our work should inform the continued growth in its use informed by the remarkable results of the EV-302 study.
Figure 1: Rates of Enfortumab-vedotin-related-cutaneous-events (EVCE) in a national cohort (FH) by race and prior therapy
Figure 1 Rates of Enfortumab-vedotin-related-cutaneous-events (EVCE) in a national cohort (FH) by race and prior therapy. The proportion of Black and White patients with EVCE is reported among all EV-treated patients, patients who had received an immune checkpoint inhibitor prior to treatment with EV, patients who had received pembrolizumab prior to treatment with EV, and patients who had received pembrolizumab within 90 days prior to treatment with EV. Odds ratios of the incidence of EVCE for Black to White patients are reported for each subgroup with 95% confidence intervals.
Written by: Evangelia Vlachou, MD1 & Vivek Nimgaonkar, MD2
- The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD
- Osler Medical Service, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD
Reference:
- Powles T, Valderrama BP, Gupta S, et al. Enfortumab Vedotin and Pembrolizumab in Untreated Advanced Urothelial Cancer. 2024;390(10):875-888.
- Oh Y, Bang A, Kurtansky N, Khan N, Pulitzer M, Noor S. Dermatologic adverse events of brentuximab vedotin: Characteristics, management, and their relationship with dose regimen. 2021;39(15_suppl):3049-3049.
- Shao K, Hooper J, Feng H. Racial and ethnic health disparities in dermatology in the United States. Part 2: Disease-specific epidemiology, characteristics, management, and outcomes. J Am Acad Dermatol. 2022;87(4):733-744.