[Novel systemic treatment options for advanced bladder cancer]

Area of Science:

• Uro-oncology
• Medical oncology
• Translational research

Background:

• Systemic treatment for urothelial carcinoma of the bladder is complex and evolving.
• Neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy is the standard for muscle-invasive bladder cancer.
• Nivolumab is recommended for cisplatin-ineligible patients.

Purpose of the Study:

• To review the current and evolving landscape of systemic treatments for urothelial carcinoma.
• To highlight emerging therapies and the importance of molecular testing.

Main Methods:

• Review of current clinical guidelines and recent clinical trial data.
• Analysis of treatment strategies for different stages of urothelial carcinoma.
• Discussion of novel therapeutic agents and their potential impact.

Main Results:

• Cisplatin-based chemotherapy followed by cystectomy remains standard for muscle-invasive disease.
• Avelumab is a maintenance option for metastatic urothelial carcinoma.
• Enfortumab vedotin and pembrolizumab show promise in first-line metastatic settings.
• Erdafitinib represents a targeted therapy option, necessitating molecular testing.

Conclusions:

• The treatment of urothelial carcinoma is rapidly advancing with new perioperative and first-line options.
• Targeted therapies and immune checkpoint inhibitors are transforming treatment paradigms.
• Molecular testing is crucial for guiding treatment decisions in advanced urothelial carcinoma.