{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T12:11:03Z","timestamp":1782907863408,"version":"3.54.5"},"reference-count":30,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T00:00:00Z","timestamp":1739145600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Urology"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>This study evaluated whether first\u2010line treatment affects survival outcomes in patients with advanced urothelial carcinoma undergoing sequential therapy with chemotherapy, immune checkpoint inhibitors, and enfortumab vedotin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This multicenter retrospective study included 57 patients treated at Hiroshima University Hospital and its affiliated institutions between 2009 and 2024. Patients received chemotherapy as a first\u2010line treatment (gemcitabine plus cisplatin or carboplatin), followed by second\u2010line immune checkpoint inhibitors (pembrolizumab or avelumab) and third\u2010line enfortumab vedotin. Assessed outcomes included overall survival and time to treatment failure. Cox regression analysis identified prognostic factors for overall survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Over a median follow\u2010up of 20.5\u2009months, median overall survival was not reached after first\u2010line treatment. Gemcitabine with cisplatin was selected in 31.6% of cases, while gemcitabine and carboplatin was chosen in 68.4% of cases as the first\u2010line treatment; subsequently, 66.7% received pembrolizumab, and 33.3% received avelumab in the second\u2010line treatment. Patients who achieved a complete or partial response with the first\u2010line treatment had significantly longer overall survivals from both first\u2010line and enfortumab vedotin initiation than those with stable or progressive disease. In cases that achieved complete or partial responses, avelumab was more frequently selected as a second\u2010line therapy. However, in the first\u2010line treatment, multivariate analysis identified only stable or progressive disease as a significant predictor of worse overall survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The best response to first\u2010line treatment predicted both overall survival from first\u2010line initiation and outcomes following enfortumab vedotin treatment, underscoring its prognostic value in sequential therapy for patients with advanced urothelial carcinoma.<\/jats:p><\/jats:sec>","DOI":"10.1111\/iju.15686","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T05:33:10Z","timestamp":1739251990000},"page":"524-530","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Influence of best objective response to first\u2010line treatment on survival outcomes in advanced urothelial carcinoma in the era of sequential therapy with enfortumab 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