Rapid first-line uptake for Padcev, but neuropathy impacts opportunity, say analysts

A recent survey by SVB Securities’ MEDAcorp unit of 48 urologists and medical oncologists suggests that Seagen (Nasdaq: SGEN) and Astellas’ (TYO: 4503) Padcev (enfortumab vedotin-ejfv) +/- Merck & Co’s (NYSE: MRK) Keytruda (pembrolizumab) may rapidly displace platinum chemo +/- Merck KGaA’s (MRK: DE) Bavencio (avelumab) maintenance as the frontline standard of care over the next three years.

The US Food and Drug Administration is currently reviewing Trevers’ss supplemental regulatory submission under the accelerated approval program for Padcev as first-line treatment for cisplatin-ineligible patients with advanced urothelial cancer. This has the potential to be a meaningful growth driver for the brand, said Seagen along with 2022 financials. Full year 2022 sales of the drug were $451 million, up 33% on 2021.

However, physicians are highly aware of Padcev's tolerability issues across lines of therapy, with survey respondents indicating that ~45% of patients are currently dose modified or discontinued from the 2L regimen due to toxicity concerns.