Newer Approaches to Treatment of Bladder Cancer

Several clinical trials in bladder cancer have resulted in FDA approvals and subsequent revisions to the NCCN Guidelines for Bladder Cancer. Cystectomy remains the primary treatment approach for bacillus Calmette-Guérin—unresponsive non–muscle-invasive bladder cancer (MIBC); however, in patients for whom such surgical intervention is not feasible, several bladder-sparing approaches are now available. In addition to neoadjuvant chemotherapy followed by resection as an established standard for MIBC, perioperative or sandwich therapy with gemcitabine plus cisplatin plus durvalumab is now also an option. The systemic treatment landscape for MIBC and metastatic disease is expanding to further incorporate antibody–drug conjugates, immune checkpoint inhibitors, and targeted therapies.