Contemporary Systemic Therapies in Urothelial Carcinoma

Prior to the past decade, systemic therapy options for muscle-invasive bladder cancer (MIBC) or locally advanced/metastatic urothelial carcinoma (la/mUC) were dismal for cisplatin-ineligible patients and after progression on chemotherapy. Although the bulk of available evidence for novel systemic therapies exists in the la/mUC setting, emerging data suggests an important role in the neoadjuvant and adjuvant spaces as well. In this narrative review, we examine the application of contemporary systemic therapies to urothelial carcinoma (UC) including immune checkpoint inhibitors (ICIs), antibody-drug conjugates (ADCs), and targeted therapies. We additionally acknowledge the potential of combination therapies to further potentiate a durable synergistic response.