Starting EV + P for bladder cancer? Here’s what to know about side effects

If doctors are treating you for muscle-invasive bladder cancer (MIBC), your treatment plan may include pembrolizumab (P) in combination with enfortumab vedotin-ejfv (EV). In July 2026, the U.S. Food and Drug Administration (FDA) expanded its approval of this combination as treatment before surgery, followed by treatment after bladder removal surgery, to include people with MIBC who are candidates for cystectomy, regardless of whether they are eligible for cisplatin-based chemotherapy.

While this combination offers an important treatment option, it can also cause side effects. Knowing what to expect and communicating changes to your care team early can help you stay as comfortable and active as possible during treatment.

Why can EV + P cause side effects?

Pembrolizumab is an immunotherapy called an immune checkpoint inhibitor. It works by helping the immune system recognize and attack cancer cells. Because it activates the immune system, it can sometimes cause inflammation in healthy organs and tissues. These immune-related side effects can affect areas including the skin, digestive system, lungs, liver, thyroid, kidneys, and nervous system.

EV is an antibody-drug conjugate, a type of targeted treatment that delivers an anticancer drug to cancer cells. It can cause its own set of side effects, including skin reactions, nerve problems, high blood sugar, lung inflammation, and eye problems.

Because the two medicines work differently, it is important to let your care team know about any new or worsening symptom, even if you are not sure whether it is related to treatment.

Common side effects to watch for

People receiving EV + P may experience:

• Tiredness or weakness
• Skin rash or itching
• Diarrhea or constipation
• Nausea or decreased appetite
• Changes in taste
• Weight loss
• Hair loss
• Numbness, tingling, or pain in the hands or feet
• Dry or irritated eyes
• Urinary tract infections

These are among the side effects reported with the combination.

Not everyone will experience these side effects, and they can range from mild to more serious. Your oncology team can recommend medications, dose changes, treatment breaks, or other strategies when needed.

Pay special attention to skin changes

Skin reactions are an important side effect of EV. Rarely, serious skin reactions can occur.

Tell your care team promptly if you develop a new rash, especially if it is spreading, painful, blistering, peeling, or accompanied by sores in your mouth or other areas.

Lifestyle tips:

• Use a gentle, fragrance-free moisturizer to help with dry skin.
• Avoid very hot showers and harsh soaps.
• Protect your skin from excessive sun exposure with clothing, shade, and sunscreen.
• Don’t start a new prescription or over-the-counter cream without checking with your care team, particularly if you have a significant rash.

Eating and drinking when your appetite is low

Nausea, changes in taste, diarrhea, constipation, and decreased appetite can make it difficult to eat and drink enough during treatment.

Instead of focusing on three large meals, try smaller meals and snacks throughout the day. Choose foods that provide protein and calories, such as eggs, yogurt, fish, poultry, beans, tofu, nut butters, or nutrition shakes, depending on your dietary preferences and what you can tolerate.

If foods taste different, experiment with different temperatures, textures, seasonings, or foods. A registered dietitian who specializes in oncology can help you develop a plan that fits your symptoms and nutritional needs.

Staying hydrated is also important, particularly if you have diarrhea, vomiting, or a decreased appetite. Ask your care team how much fluid you should drink each day, especially if you have kidney, heart, or other conditions that affect your fluid intake.

Protecting your nerves

EV can cause peripheral neuropathy, which may feel like numbness, tingling, burning, pain, or weakness in your hands or feet.

Tell your care team as soon as you notice these symptoms. Early recognition is important because your team may be able to adjust treatment to prevent symptoms from becoming more severe.

At home, take extra precautions if you have numbness or weakness:

• Keep walkways clear to reduce your risk of falling.
• Use handrails on stairs.
• Check the temperature of bath water carefully to avoid burns.
• Wear supportive, well-fitting shoes.
• Ask for help with activities that require good balance or coordination.

Remember: immune-related side effects can happen later

One important difference with pembrolizumab is that immune-related side effects do not always happen immediately after an infusion. They can develop during treatment and, in some cases, after treatment has ended.

That means you should continue to tell your health care team about new or unexplained symptoms, even if you have been feeling well or your last treatment was weeks or months ago.

You don’t have to manage side effects on your own. Your oncology team would rather hear about a symptom early than have you wait until it becomes severe. Treatment may sometimes need to be paused or adjusted while a side effect is evaluated and treated.

Most importantly, keep an open line of communication with your oncology team. Ask what symptoms you should report immediately, which can wait until your next appointment, and who to contact after hours.

Your treatment plan should address more than the cancer itself. Managing side effects and supporting your quality of life are important parts of your care, too.

Disclaimer: The information provided in this article is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Outcomes4Me is not acting as your caregiver, and any suggestions or guidance offered should not replace the advice of your healthcare provider or qualified medical professional. Always seek the guidance of your physician or other qualified health provider with any questions you may have regarding a medical condition.