Platinum-based chemotherapy (cisplatin, or carboplatin in cisplatin-ineligible patients) has long been the standard first-line treatment for locally advanced or metastatic urothelial carcinoma. However, immunotherapies and antibody–drug conjugates (ADCs) have profoundly reshaped the treatment landscape. Since 2020, avelumab has become the standard first-line maintenance therapy for patients without disease progression following platinum-based chemotherapy. In 2022, enfortumab vedotin (EV) was approved for use after platinum-based chemotherapy and anti-PD-(L)1 therapy; and, since late 2024, the combination of EV plus pembrolizumab has become the preferred first-line treatment for eligible patients. Despite these advances, bladder cancer remains common and is associated with a poor prognosis, with a 5-year survival rate of <10% in the metastatic setting, highlighting substantial unmet needs.
