Kazuhide Makiyama

Objective In December 2021, enfortumab vedotin (EV), an antibody‐drug conjugate directed against nectin‐4, was approved in Japan as a new treatment after platinum‐containing chemotherapy and PD‐1/PD‐L1 inhibitors. This study evaluated, using real‐world data, the efficacy and safety of EV therapy in patients with metastatic urothelial carcinoma (mUC). Materials and methods Fifty‐five patients with mUC who discontinued pembrolizumab therapy due to disease progression between June 2018 and April 2023 at Yokohama City University Hospital were evaluated retrospectively. Of the 55 patients, 25 received EV therapy (EV group) and 30 did not (non‐EV group). All patients who underwent EV therapy were diagnosed with disease progression after the approval of EV in Japan. Results The median (range) follow‐up period after pembrolizumab discontinuation was 6.3 (0.7–31.1) months. There were eight (32.0%) deaths due to cancer in the EV group and 27 (90.0%) in the non‐EV group. The overall survival (OS) after pembrolizumab discontinuation was not reached in the EV group versus 2.6 months in the non‐EV group ( p < 0.001). A multivariate analysis revealed that EV therapy (EV vs. non‐EV group; hazard ratio 0.26; 95% confidence interval 0.16–0.41; p < 0.001) was an independent prognostic factor for OS. Conclusion EV prolonged OS in mUC following pembrolizumab therapy in real‐world data.

Partial nephrectomy (PN) is the standard treatment for T1 renal cell carcinoma. PN is affected more by surgical variations and requires greater surgical experience than radical nephrectomy. Patient‐specific simulations and navigation systems may help to reduce the surgical experience required for PN. Recent advances in three‐dimensional (3D) virtual reality (VR) imaging and 3D printing technology have allowed accurate patient‐specific simulations and navigation systems. We reviewed previous studies about patient‐specific simulations and navigation systems for PN. Recently, image reconstruction technology has developed, and commercial software that converts two‐dimensional images into 3D images has become available. Many urologists are now able to view 3DVR images when preparing for PN. Surgical simulations based on 3DVR images can change surgical plans and improve surgical outcomes, and are useful during patient consultations. Patient‐specific simulators that are capable of simulating surgical procedures, the gold‐standard form of patient‐specific simulations, have also been reported. Besides VR, 3D printing is also useful for understanding patient‐specific information. Some studies have reported simulation and navigation systems for PN based on solid 3D models. Patient‐specific simulations are a form of preoperative preparation, whereas patient‐specific navigation is used intraoperatively. Navigation‐assisted PN procedures using 3DVR images have become increasingly common, especially in robotic surgery. Some studies found that these systems produced improvements in surgical outcomes. Once its accuracy has been confirmed, it is hoped that this technology will spread further and become more generalized.