Bladder Cancer Treatment Updates

Urothelial carcinoma is the sixth most common malignancy in the United States. Althoughmost are diagnosed with no- muscle-invasive malignancy, many patients will developrecurrent disease within years, with 10% to 20% developing advanced muscle-invasive ormore distant incurable disease. Despite multidisciplinary advances in urothelial carcinoma, clinical outcomes remainsuboptimal for those with advanced disease, with 5-year survival rates typically less than15%. For patients with metastatic disease, first-line platinum-based chemotherapy remainsstandard of care for those who are cisplatin eligible. For patients with recurrent disease after chemotherapy, there has been FDA approval of fivediff erent PD-1/ PD-L1 inhibitors since May 2016, with both atezolizumab andpembrolizumab also approved as first-line therapy for patients ineligible to receive cisplatinchemotherapy. There are number of promising targeted therapies currently undergoing study in advancedurothelial carcinoma, including VEGF receptor antibodies, selective FGFR inhibitors, andantibody-drug conjugates such as enfortumab vedotin, targeting Nectin-4. As multitude of drugs continue to be invetigated, the treatment paradigm continues tochange with ongoing research aimed at how best to incorporate these newer agents withcurrent well-established therapies or in novel combinations with other treatment modalitiesat various stages of disease.