Prepare the filling by combining pumpkin puree, softened cream cheese (if using), brown sugar, cinnamon, nutmeg, and ginger in a bowl. Mix until smooth and creamy. This filling is where all the pumpkin spice goodness lives, so taste it and adjust the sweetness or spices if you like.
Using a rolling pin or your hands, flatten each bread slice gently until it’s about 1/4-inch thick. This makes the bread easier to roll without cracking. Spread about two tablespoons of the pumpkin filling evenly on one side of each flattened bread slice, leaving a small border around the edges.
Carefully roll up each slice, starting from one edge and rolling tightly but gently to avoid squeezing out the filling. Place the roll-ups seam side down on a plate to keep them from unrolling while you prepare the egg batter.
In a shallow bowl, whisk together eggs, milk, and vanilla extract. This mixture will give your roll-ups that classic French toast flavor and help them get golden and crispy.
Heat a non-stick skillet or griddle over medium heat and add a little butter or oil. Dip each roll-up into the egg mixture, turning to coat all sides well but not letting them soak too long or they’ll get soggy. Place the roll-ups seam side down in the pan. Cook for about 2-3 minutes on each side or until all sides are golden brown and crispy.
Remove the cooked roll-ups to a serving plate. Dust lightly with powdered sugar if you like and serve warm with maple syrup on the side. These are best enjoyed fresh but can be stored for later.