his prospective exploratory study aims to describe the course of peripheral neuropathy in patients with locally advanced or metastatic urothelial carcinoma treated with enfortumab vedotin in combination with pembrolizumab and receiving supportive Neuridase.

Peripheral neuropathy is a common adverse event associated with enfortumab vedotin and may negatively affect treatment tolerability, quality of life, and treatment continuation. Neuridase is a non-pharmacological supportive product intended to support peripheral nervous system function; however, its role in this clinical setting has not yet been established.

Participants enrolled in this single-arm study will receive standard-of-care treatment with enfortumab vedotin plus pembrolizumab, together with supportive Neuridase according to clinical practice. The study will prospectively assess neuropathy symptoms and severity using clinical evaluations and patient-reported outcome measures, including quality-of-life questionnaires, over the course of treatment.

The objective of the study is to explore neuropathy patterns and treatment tolerability in this patient population.

IInclusion Criteria:

• Age ≥18 years
• Histologically confirmed locally advanced or metastatic urothelial carcinoma
• Candidate for treatment with enfortumab vedotin in combination with pembrolizumab according to clinical practice
• Ability to provide written informed consent
• Adequate clinical conditions to participate in the study according to investigator judgment

Exclusion Criteria:

• Pre-existing severe peripheral neuropathy that may interfere with study assessments
• Contraindications to enfortumab vedotin or pembrolizumab according to clinical practice
• Known hypersensitivity to components of Neuridase
• Pregnancy or breastfeeding
• Any medical, psychiatric, or social condition that, in the investigator's judgment, may interfere with study participation or interpretation of results

De-identified individual participant data collected during the study will not be made publicly available. Data sharing may be considered on reasonable request to the study investigators and in accordance with institutional policies, ethical approvals, and applicable data protection regulations.