Sacituzumab Govitecan Plus EV in Metastatic UC

This study tests a combination of two targeted antibody-drug therapies — sacituzumab govitecan and enfortumab vedotin — with or without the immunotherapy drug pembrolizumab, for patients with advanced bladder or urinary tract cancer (called urothelial carcinoma) that has stopped responding to prior treatments. **You may be eligible if:** - You are 18 or older with confirmed urothelial carcinoma (bladder, kidney pelvis, ureter, or urethra) - Your cancer has progressed on or after prior treatment (including platinum-based chemotherapy and/or immunotherapy) - You have measurable disease on imaging - Your organ function (kidneys, liver, blood) meets minimum standards - You are willing to use contraception during treatment and for 6 months afterward **You may NOT be eligible if:** - You are pregnant or breastfeeding - You have previously received these specific drugs (topoisomerase 1 inhibitors, sacituzumab govitecan, or enfortumab vedotin) - You have active brain metastases or carcinomatous meningitis - You have serious heart problems, active infection, active inflammatory bowel disease, or uncontrolled diabetes - You have a history of certain autoimmune diseases (for the pembrolizumab cohort) Talk to your doctor to see if this trial is right for you.