Scientific rationale

The combination of Enfortumab Vedotin and Pembrolizumab has recently transformed the therapeutic scenario of urothelial carcinoma, affirming itself as a new standard of care in the front line in the metastatic setting and as a strategy in rapid expansion also within the perioperatory framework. With the extension of treatment to populations of increasingly broader patients and precocious disease stages, an optimal management of toxicity becomes essential to ensure therapeutic continuity, maintain dose intensity and preserve quality of life.

• Although generally controllable, neurological, dermatological and cardiovascular toxicities may have a significant impact on adherence to treatment if not recognized and addressed early. Their presentation can be heterogeneous, sometimes subdule debut and overlap, especially with therapeutic combination, can be a challenge in everyday clinical practice. For this reason, a multidisciplinary, proactive and structured approach is essential, capable of fostering early diagnosis, correct differential evaluation and appropriate therapeutic intervention.