Recent Advancements in Muscle-Invasive Urothelial Carcinoma

Recent advancements in the management of muscle-invasive urothelial carcinoma (MIUC) have centered on integrating immunotherapy and targeted approaches. Immune checkpoint inhibitors, such as PD-1/PD-L1 blockers, have become important in both neoadjuvant and adjuvant settings, especially for cisplatin-ineligible patients.

A key innovation is the use of antibody-drug conjugates (ADCs), notably enfortumab vedotin, which targets Nectin-4. When combined with checkpoint inhibitors like pembrolizumab, this approach has shown synergistic anti-tumor activity in advanced urothelial carcinoma. Ongoing trials are now exploring these combinations in earlier stages, including the neoadjuvant setting for MIUC.

These developments, alongside advances in molecular profiling and biomarker-guided therapy, are redefining treatment paradigms—offering new hope for improved outcomes and potential bladder preservation in selected patients.