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Treatment efficacy for locally advanced or metastatic urothelial carcinoma (la/mUC) can vary across molecular and histological subtypes.1-3 Selection of platinum-based chemotherapy depends on rigorous eligibilty criteria, including performance status and comorbitity assessments to minimize treatment-related toxicity.1-3 Recently, the 1L treatment landscape for la/mUC has transformed with the emergence of antibody-drug conjugates (ADCs) and targeted therapies, expanding options beyond conventional chemotherapy.1,3,4 However, optimal selection of 1L treatment remains complex, particularly in individuals who may be ineligible for a specific treatment or those with contraindicated conditions.2,4 Precision medicine approaches, focused on individualized care and shared decision-making between patients and clinicians, are increasingly recognized as essential for aligning treatment choices with patient-centered goals.5,6 In this activity, watch an international panel of experts discuss the latest clinical trial and real-world evidence informing individualized 1L treatment strategies for patients with la/mUC and the emerging biomarkers guiding therapeutic selection.
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Powles T, Bellmunt J, Comperat E, et al. ESMO Clinical Practice Guideline interim update on first-line therapy in advanced urothelial carcinoma. Ann Oncol. 2024;35:485–490.
EAU. EAU guidelines on muscle-invasive and metastatic bladder cancer. 2025. Available at: https://uroweb.org/guidelines/muscle-invasive-and-metastatic-bladder-cancer (accessed October 15, 2025).
NCCN. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Bladder Cancer. 2025. Available at: www.nccn.org/professionals/physician_gls/pdf/bladder.pdf (accessed October 15, 2025).
Xie Y, Liu H, Tang Y, et al. First-line systemic therapy in patients with metastatic or locally advanced urothelial carcinoma: a systematic review and network meta-analysis of randomized controlled trials. Ther Adv Med Oncol. 2025;17:17588359251357527.
Grivas P, Veeranki P, Chiu K, et al. Preferences for first-line treatment of advanced urothelial carcinoma among US practicing oncologists and patients. Future Oncol. 2023;19:369–383.
Apolo AB, Michaels-Igbokwe C, Simon NI, et al. Patient preferences for first-line treatment of locally advanced or metastatic urothelial carcinoma: an application of multidimensional thresholding. Patient. 2025;18:77–87.
Dr Alison Birtle is a Consultant Clinical Oncologist and Honorary Clinical Professor at the University of Manchester and University of Central Lancashire. She specializes in the treatment of urological cancers, particularly prostate, bladder and testicular tumors. Dr Birtle is an advisor on patient information related to urological cancers for Macmillan Cancer Support and Fight Bladder Cancer. In addition, she is the secretary to the British Uro-Oncology Group, and a member of the European Association of Urology’s NMIBC and UTUC Guidelines Groups. Dr Birtle has immense research experience and has served as Clinical Research Lead for Lancashire and South Cumbria Cancer Research Network, as Specialty Group Lead for Cancer Research North-West Coast and as an Associate Cancer Research Lead for the CRN North-West Coast. She has published widely and has been the Principal and Chief Investigator on many urological clinical trials, such as the POUT trial, which has been incorporated into the European Urology Guidelines. Furthermore, she has received numerous awards for her excellent work, including being named one of the 70 national stars of the NHS and the NWCCRN Research Practitioner of the Year. As a member of the European Society of Medical Oncology, and previously of the RCR Academic Committee for Clinical Oncology, she is passionate about patient access to clinical trials and combines her love for research with full-time NHS work.
Consulting or advisory fees from Astellas Medivation, AstraZeneca, Bayer Schering Pharma, Bristol Myers Squibb, Gilead, Janssen, Macrogenics, Merck, MSD, Pfizer, Roche, and Sanofi. Honoraria from Janssen. Provided speaker services to Astellas, Bayer, Janssen, Merck, and Pfizer. Received research funding from Genzyme.
Dr Enrique Grande is the Director of the Cancer Program at Quirónsalud, the largest private hospital network in Spain, and Adjunct Professor in the Genitourinary Medical Oncology Department at The University of Texas MD Anderson Cancer Center. Dr Grande’s clinical and research activity is focused on genitourinary and endocrine tumors, with a strong track record in translational research and early drug development. Dr Grande has published over 300 peer-reviewed manuscripts and has played a key role in several landmark clinical trials in bladder cancer, contributing to the approval of novel therapies. Dr Grande is also part of the steering committee of several pivotal trials and a recognized international leader in the field.
Honoraria from AbbVie, Adium, Advanced Accelerator Applications, Astellas Pharma, AstraZeneca, AVEO, Bayer, Bristol Myers Squibb, Clovis-Oncology, Dr. Reddy’s, Eisai, Esteve, Eusa Pharma, GSK, IMVAX, Ipsen, ITM-Radiopharma, Janssen, Lilly, Merck, MSD, Novartis, Palex, Pfizer, Raffo, Roche, Rovi, and Tecnofarma. Received research grants from Astellas Pharma, AstraZeneca, Merck, Nanostring Technologies, Pfizer, and Roche. Leadership roles in medical societies for ENETS, ESMO, GETNE, Grupo Centro de Tumores Genitourinarios, and GUARD consortium. Private healthcare provider at MD Anderson Cancer Center Madrid (prior workplace); Commercial Medical Education provider at Universidad Francisco de Vitoria (UFV), Oncology Information Group (Oncinfo), Permanyer, and ACE Oncology. Stocks or ownership interest in Amarin Corp, Bicycle Therapeutics, and Pharmamar S.A.
Dr Joana Marinho is currently a Medical Oncologist working at the Gaia e Espinho Local Health Unit, specializing in genitourinary and gastrointestinal tumors, and geriatric oncology. She is also the Coordinator of the Oncology Day Hospital. Dr Marinho has been awarded a PhD for her work in Biochemistry and Molecular Biology from the University of Coimbra and holds a postgraduate degree in Venous Thromboembolic Disease and Cancer from the Catholic University of Murcia. Dr Marinho is proactive in contributing to national and international oncology organisations. She holds various leadership positions, such as the President of the Association for Research and Supportive Care in Oncology and a Portuguese affiliate of the Multinational Association of Supportive Care in Cancer (MASCC). As a MASCC member she contributes to the Geriatrics Study Group, promoting research and training in supportive care. Furthermore, she is part of the International Society of Geriatric Oncology and the Portuguese Oncology Society, where she collaborates with the Geriatric Oncology Working Group and the Liver Tumour Study Group. As a member of the European Organisation for Research and Treatment of Cancer, Dr Marinho actively contributes to genitourinary and gastrointestinal groups and is committed to teaching in her role as an adjunct professor at the School of Nursing Red Cross.
Travel and/or meeting support from Merck, Pierre-Fabre, and Servier. Consulting fees from AstraZeneca, Merck, and Servier. Honoraria from Astellas, AstraZeneca, Merck, Nutricia, and Servier.
Dr Niklas Klümper is a senior physician at the Department of Urology and Pediatric Urology at University Hospital Bonn, where he also leads a translational research group in collaboration with the Institute of Experimental Oncology. His work focuses on uro-oncology, particularly predicting treatment response and developing personalized therapies. Key research areas include early detection of response to immunotherapies and investigating resistance mechanisms to antibody-drug conjugates.
Honoraria from Astellas Pharma, Ipsen, Merck, MSD, Novartis, and Photocure. Consulting or advisory fees from Astellas Pharma, Axiom HCS, Bicycle Therapeutics, Eisai, LabGenius, and MSD. Received research funding from Bicycle Therapeutics.
Dr David Benjamin is a genitourinary oncologist at the Hoag Family Cancer Institute, USA. He is actively involved in multiple clinical trials and research projects. Dr Benjamin has co-authored over 70 publications in renowned journals such as the Journal of American Medical Assocation Oncology and Nature Reviews Urology. Dr Benjamin has previously served as a reviewer for numerous medical journals and is currently an editorial board member for the European Society for Medical Oncology Rare Cancers.
Consulting or advisory fees from AIMED BIO, Astellas Pharma, AVEO Oncology, Bayer, Dendreon, Eisai, Exelixis, GlaxoSmithKline, Janssen, Janux, Merck, and Seagen. Speakers’ bureau for MSD. Received travel and accommodations from DAVA Oncology, Janux, Merck, MSD, and Seagen.
This medical activity has been sponsored by Merck KGaA, Darmstadt, Germany (CrossRef Funder ID: 10.13039/100009945).
Merck KGaA, Darmstadt, Germany provided financial support and video content, and has had input into the detailed project scope. EMD Serono is the healthcare business of Merck KGaA, Darmstadt, Germany in Canada and the US. This medical activity is hosted by Touch Medical Communications (TMC) for touchONCOLOGY.
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Merck KGaA, Darmstadt, Germany provided financial support and video content, and has had input into the detailed project scope. EMD Serono is the healthcare business of Merck KGaA, Darmstadt, Germany in Canada and the US. This medical activity is hosted by Touch Medical Communications (TMC) for touchONCOLOGY.
Unapproved products or unapproved uses of approved products may be discussed; these situations may reflect the approval status in one or more jurisdictions. TMC has advised the sponsor to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by TMC of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in TMC activities. TMC accepts no responsibility for errors or omissions.
The views and opinions expressed are those of the faculty and do not necessarily reflect those of any sponsor.
GL-AVE-00902
Date of preparation: January 2026
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