Consolidative Surgery for Advanced Upper Urinary Tract Urothelial Carcinoma After Enfortumab Vedotin and/or Immune Checkpoint Inhibitors.

Upper urinary tract urothelial carcinoma (UTUC) is a rare malignancy with a poor prognosis in advanced disease. With the advent of novel systemic therapies, including enfortumab vedotin (EV) and immune checkpoint inhibitors (ICIs), deep and durable responses can now be achieved, potentially enabling consolidative surgery with curative intent. However, evidence supporting this approach in advanced UTUC remains scarce. We report a case series of five patients with advanced UTUC who underwent consolidative surgery after EV and/or ICI therapy. All patients achieved sufficient disease control with systemic therapy to allow surgical consolidation, including cases in which the primary tumor showed regrowth and metastatic lesions had nearly or completely resolved during systemic therapy. Consolidative surgery was successfully performed with negative surgical margins in all cases. At a median follow-up of 12 (6-30) mo after surgery, all five patients remained alive, with no evidence of disease, and three patients achieved complete discontinuation of systemic therapy. These findings suggest that consolidative surgery after modern systemic therapy, including EV and/or ICIs, may provide durable disease control and treatment-free survival in selected patients with advanced UTUC.