Treatment of Metastatic Bladder Cancer

Yu Fujiwara, Hirotaka Miyashita, Matthew D. Galsky

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


The treatment for metastatic bladder cancer had been limited to cisplatin-based chemotherapy for decades. However, a better understanding of the molecular biology and the tumor microenvironment of bladder cancer has unlocked new opportunities for treatment. Immune checkpoint blockade with programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) antibodies has demonstrated durable responses in a subset of patients in the first- and second-line settings. Mutations in fibroblast growth factor receptor (FGFR), known to occur in bladder cancer for some time, have become “actionable” with erdafitinib, a pan-FGFR inhibitor. Enfortumab vedotin, an antibody-drug conjugate directed against nectin-4, became the first of this therapeutic class integrated into the bladder cancer armamentarium. Current efforts are focused on understanding how to optimally combine or sequence these distinct therapeutic classes to further improve outcomes for patients with metastatic bladder cancer. This chapter focuses on the current therapeutic options for metastatic bladder cancer and gives a perspective on the future treatment of this disease.

Original languageEnglish
Title of host publicationUrologic Oncology
Subtitle of host publicationMultidisciplinary Care for Patients
PublisherSpringer International Publishing
Number of pages17
ISBN (Electronic)9783030898915
ISBN (Print)9783030898908
StatePublished - 1 Jan 2022


  • ADC Antibody-drug conjugate
  • AE Adverse event
  • Abbreviations
  • Antibody-drug conjugate
  • BC Bladder cancer
  • CPS Combined positive score
  • CTLA-4 Cytotoxic T-lymphocyte antigen 4
  • Chemotherapy
  • ECOG PS Eastern Cooperative Oncology Group performance status
  • Enfortumab vedotin
  • FDA The US Food and Drug Administration
  • FGFR Fibroblast growth factor receptor
  • FGFR inhibitor
  • GC Gemcitabine plus cisplatin
  • GCa Gemcitabine plus carboplatin
  • GFR Glomerular filtration rate
  • HER2 Human epidermal growth factor receptor 2
  • Immune checkpoint inhibitor
  • Immunotherapy
  • KPS Karnofsky performance status
  • M-CAVI Methotrexate, carboplatin, and vinblastine
  • MVAC Methotrexate, vinblastine, doxorubicin, and cisplatin
  • ORR Overall response rate
  • OS Overall survival
  • PD-1 Programmed cell death protein 1
  • PD-L1 Programmed death-ligand 1
  • PFS Progression-free survival
  • PGC Paclitaxel, gemcitabine, and cisplatin
  • RCT Randomized controlled trial
  • TRAE Treatment-related adverse event
  • UC Urothelial carcinoma
  • Urothelial carcinoma
  • VEGF Vascular endothelial growth factor
  • VEGFR VEGF receptor
  • VG Vinflunine plus gemcitabine
  • ddMVAC Dose-dense MVAC
  • etastatic bladder cancer


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