Advanced bladder cancer

Authored by Open Medicine, published on 2026-07-24 00:03:27.0

First-line treatment for advanced urothelial carcinoma now prioritizes enfortumab vedotin plus pembrolizumab, with alternatives including platinum-based chemotherapy followed by avelumab maintenance or chemo-immunotherapy combinations. Subsequent therapy is guided by prior exposure and biomarkers, incorporating options such as erdafitinib for FGFR-altered disease, HER2-targeted therapy, immunotherapy, or EV if not previously used.

  1. Advanced bladder cancer
    This is the top-level disease-state node; contemporary guidelines synthesize recommended first-line and subsequent-line systemic therapy options for locally advanced/metastatic urothelial carcinoma, including EV+P, platinum chemotherapy, avelumab maintenance, and biomarker-directed treatments.
    • EV + Pembrolizumab
      • - FGFR3 alteration: Erdafitinib - HER2+: T-DXd - Pembrolizumab (if not used before) - EV (if not used before) - Platinum/Gemcitabine (if not used before)
    • Nivolumab + Cis/Gem
      • - FGFR3 alteration: Erdafitinib - HER2+: T-DXd - Pembrolizumab (if not used before) - EV (if not used before) - Platinum/Gemcitabine (if not used before)
    • - Dd MVAC - Cis/Gem - Carbo/Gem
      • Avelumab
tosprivacyNCCN Bladder Cancer GuidelinesESMO Clinical Practice Guideline interim update on first-line therapy in advanced urothelial carcinomaEAU Muscle-invasive and Metastatic Bladder Cancer GuidelinesHow to Treat Bladder Cancer – Drs. Stephanie Berg (Medical Oncologist) & Joshua Meeks (Urologist)ESMO Clinical Practice Guideline interim update on first-line therapy in advanced urothelial carcinomaEuropean Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2025 GuidelinesUromigos Episode 504: ASCO 2026 - ADC Drug Development in Urothelial CancerEnfortumab Vedotin and Pembrolizumab in Untreated Advanced Urothelial CancerAvelumab Maintenance Therapy for Advanced or Metastatic Urothelial CarcinomaPembrolizumab as Second-Line Therapy for Advanced Urothelial CarcinomaEnfortumab Vedotin in Previously Treated Advanced Urothelial CarcinomaErdafitinib in Locally Advanced or Metastatic Urothelial CarcinomaEfficacy and Safety of Trastuzumab Deruxtecan in Patients With HER2-Expressing Solid Tumors: Primary Results From the DESTINY-PanTumor02 Phase II Trial