The king has been dethroned

Genitourinary MedicalOncologists of Canada (GUMOC) consensus on the management of unresectable locally advanced and metastatic urothelial carcinoma, published in 2019, marked a pivotal moment in the field. 1 It arrived just as we were navigating an unprecedented influx of early-phase trials involving immune checkpoint inhibitors (ICIs) for patients who were refractory or ineligible to platinum.The uro-oncology community was then just transitioning from applauding results at conferences and implementing ICIs in clinics to grappling with the complexities of programmed death-ligand 1 (PD-L1) assays and lack of predictive markers of response.It was evident that we were at the forefront of a significant shift; however, the shadow of the threedecade-long hegemony of platinum doublet persisted in treatment-naive patients, with the same "old" benefits and challenges.Little did we know that changes were just beginning.Fast forward to the 2024 edition of the report in this month's issue of CUAJ, which introduces new classes of therapy against bladder cancers, including novel antibody-drug conjugates (ADC), targeted therapies, and new combination regimens. 2The authors meticulously dissect practice-changing trials and their implementation across first-line treatment, both de novo and post-adjuvant ICI, as well as second-line and beyond.This progress represents much-anticipated breakthroughs for patients and clinicians.Most notably, enfortumab vedotin combined with pembrolizumab (EV + P) has replaced cisplatin-based chemotherapy as the new gold-standard first-line treatment in this