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Novel Strategies and Therapeutic Advances for Bladder Cancer
Division of Hematology & Oncology, Columbia University Irving Medical Center, New York, NY 10032, USA
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Author to whom correspondence should be addressed.
Cancers 2025, 17(13), 2070; https://doi.org/10.3390/cancers17132070
Submission received: 27 May 2025
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Revised: 18 June 2025
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Accepted: 19 June 2025
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Published: 20 June 2025
(This article belongs to the Special Issue Advancements in Bladder Cancer Therapy)
Simple Summary
Platinum-based chemotherapy had been the backbone of bladder cancer treatment for decades until the advances of the last few years. Chemoimmunotherapy regimens and antibody–drug conjugates have revolutionized the treatment of both localized and advanced disease, leading to changes in the consensus guidelines. Ongoing trials are investigating bladder-sparing approaches in the localized setting, as well as novel therapies for all stages of disease.
Abstract
Background/Objectives: To summarize the relevant trials relating to novel strategies and therapeutic advances in the treatment of bladder cancer. Methods: A comprehensive review of the literature and recent/ongoing clinical trials was conducted, focusing on novel treatments and strategies for bladder cancer. Trials started or published as of 2020 were included. Results: The standard of care for MIBC remains neoadjuvant chemotherapy with perioperative immunotherapy in the cisplatin-eligible population, while guidelines do not exist for cisplatin-ineligible patients. Strategies under investigation include combinations of chemotherapy, immunotherapy, radiation, and/or novel therapies, such as ADCs, targeted agents, intravesical treatments, and personalized vaccines. Bladder-sparing approaches using these novel therapies are also being studied. In the advanced/metastatic setting, enfortumab vedotin plus pembrolizumab has supplanted platinum-based chemotherapy as the first-line treatment option. For those with contraindications, or who progress, strategies under investigation include newer immunotherapies and ADCs, novel small molecule inhibitors, and cellular therapies. Conclusions: The treatment landscape for bladder cancer has changed drastically within the last few years. Ongoing trials hope to build on this success by investigating bladder-sparing strategies for MIBC and novel systemic therapies in advanced patients.
