Zelenectide pevedotin (BT-8009): a bicyclic peptide toxin conjugate targeting nectin-4 for the treatment of bladder cancer

Introduction: Zelenectide pevedotin (BT8009) is a novel Bicycle Toxin Conjugate targeting nectin-4, designed to overcome the limitations of already existing anti-nectin-4 antibody-drug conjugates such as enfortumab vedotin (EV). Its innovative molecular design enhances tumor penetration, minimizes systemic toxicity, and achieves therapeutic efficacy independent from internalization. Areas covered: This review evaluates the preclinical rationale and clinical data for BT8009, focusing on its pharmacokinetic properties, safety, and efficacy compared to EV. Key findings from the ongoing phase I/II Duravelo-1 trial are analyzed alongside challenges in the design of the phase II/III Duravelo-2 trial and their potential implications for future clinical development. Expert opinion: Preliminary data on BT8009 reveal an intriguing clinical profile, with promising efficacy and a notable safety profile. However, the design of ongoing trials raises concerns, particularly due to the use of outdated control arms and the lack of direct comparisons to EV. These limitations could delay its clinical adoption and regulatory approval, impacting on its positioning in an increasingly competitive therapeutic landscape. Nonetheless, if ongoing and future trials confirm its efficacy and safety advantages, BT8009 could represent a valuable advancement for the treatment of nectin-4 expressing solid tumors such as urothelial carcinoma, warranting further investigation in more robust comparative studies.