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Evolving Therapies for Urothelial Carcinoma—Novel Paradigms and Future Directions

Published Online: December 23rd 2020 Oncology & Hematology Review. 2020;16(2): Online ahead of journal publication
Authors: Madison Williams, Ryan Williams, Daruka Mahadevan, Chethan Ramamurthy
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Within the last 5 years, multiple therapeutic options have been approved for the treatment of locally advanced and metastatic urothelial carcinoma. The standard of care for first-line therapy remains cisplatin-based chemotherapy; however, a significant number of patients are ineligible for treatment with cisplatin-based therapy. Immune checkpoint inhibitors have been approved for use in both the first-line (pembrolizumab and atezolizumab) and second-line (atezolizumab, durvalumab, avelumab, nivolumab, and pembrolizumab) settings for cisplatin-ineligible patients who are either programmed death-ligand 1-positive or are unable to tolerate chemotherapy. Recent data also establish maintenance immunotherapy as a new standard of care for platinum-eligible patients in the front-line setting. Here we review the role of immunotherapeutic agents in locally advanced and metastatic urothelial carcinoma, along with the role of maintenance immunotherapy post-platinum-based chemotherapy, ongoing trials of combination immunotherapy and chemotherapy, antibody–drug conjugates, and fibroblast growth factor receptor-targeted therapy options for patients who are refractory to or ineligible for platinum-based therapy.


Urothelial carcinoma, immunotherapy, targeted therapy, antibody–drug conjugates, refractory, metastatic, advanced


**This manuscript has been accepted for publication, but may be subject to minor changes during the production process.**

Article Information:

Madison Williams, Ryan Williams, Daruka Mahadevan, and Chethan Ramamurthy have no financial or non-financial relationships or activities to declare in relation to this article.

Compliance With Ethics

This article involves a review of the literature and did not involve any studies with human or animal subjects performed by any of the authors.

Review Process

Double-blind peer review.


The named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.


Chethan Ramamurthy, Division of Hematology and Oncology, University of Texas Health Science Center San Antonio, 7979 Wurzbach Road, San Antonio, TX 78229, USA. E: ramamurthyc@uthscsa.edu


No funding was received in the publication of this article.

Open Access

This article is freely accessible at touchONCOLOGY.com © Touch Medical Media 2020.



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