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Bladder CancerA Review

Educational Objective
To review the clinical management of bladder cancer.
1 Credit CME

Importance  Bladder cancer is a common malignancy in women and is the fourth most common malignancy in men. Bladder cancer ranges from unaggressive and usually noninvasive tumors that recur and commit patients to long-term invasive surveillance, to aggressive and invasive tumors with high disease-specific mortality.

Observations  Advanced age, male sex, and cigarette smoking contribute to the development of bladder cancer. Bladder tumors can present with gross or microscopic hematuria, which is evaluated with cystoscopy and upper tract imaging depending on the degree of hematuria and risk of malignancy. Non–muscle-invasive tumors are treated with endoscopic resection and adjuvant intravesical therapy, depending on the risk classification. Enhanced cystoscopy includes technology used to improve the detection of tumors and can reduce the risk of recurrence. Patients with high-risk non–muscle invasive tumors that do not respond to adjuvant therapy with the standard-of-care immunotherapy, bacille Calmette-Guérin (BCG), constitute a challenging patient population to manage and many alternative therapies are being studied. For patients with muscle-invasive disease, more aggressive therapy with radical cystectomy and urinary diversion or trimodal therapy with maximal endoscopic resection, radiosensitizing chemotherapy, and radiation is warranted to curb the risk of metastasis and disease-specific mortality. Treatment of patients with advanced disease is undergoing rapid changes as immunotherapy with checkpoint inhibitors, targeted therapies, and antibody-drug conjugates have become options for certain patients with various stages of disease.

Conclusions and Relevance  Improved understanding of the molecular biology and genetics of bladder cancer has evolved the way localized and advanced disease is diagnosed and treated. While intravesical BCG has remained the mainstay of therapy for intermediate and high-risk non–muscle-invasive bladder cancer, the therapeutic options for muscle-invasive and advanced disease has expanded to include immunotherapy with checkpoint inhibition, targeted therapies, and antibody-drug conjugates.

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Article Information

Corresponding Author: Karim Chamie, MD, MSHS, Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine at UCLA, 300 Stein Plaza, Ste 370, Los Angeles, CA 90095 (

Accepted for Publication: August 26, 2020.

Author Contributions: Drs Lenis and Chamie had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design, acquisition, analysis, or interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, and supervision: All authors.

Conflict of Interest Disclosures: Dr Chamie reported serving as a consultant for UroGen Pharma and receiving research funding from Salix Pharma. No other disclosures were reported.

Richters  A , Aben  KKH , Kiemeney  LALM .  The global burden of urinary bladder cancer: an update.   World J Urol. 2020;38(8):1895-1904. PubMedGoogle ScholarCrossref
Siegel  RL , Miller  KD , Jemal  A .  Cancer statistics, 2019.   CA Cancer J Clin. 2019;69(1):7-34. PubMedGoogle ScholarCrossref
Chang  SS , Boorjian  SA , Chou  R ,  et al.  Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO guideline.   J Urol. 2016;196(4):1021-1029. doi:10.1016/j.juro.2016.06.049PubMedGoogle ScholarCrossref
Chang  SS , Bochner  BH , Chou  R ,  et al.  Treatment of non-metastatic muscle-invasive bladder cancer: AUA/ASCO/ASTRO/SUO guideline.   J Urol. 2017;198(3):552-559. doi:10.1016/j.juro.2017.04.086PubMedGoogle ScholarCrossref
Barocas  DA , Boorjian  SA , Alvarez  R ,  et al. Microhematuria: AUA/SUFU guideline. American Urological Association. Published 2020. Accessed June 28, 2020.
Babjuk  M , Burger  M , Comperat  E ,  et al. European Association of Urology non-muscle invasive bladder cancer guidelines. Published 2020. Accessed June 21, 2020.
Witjes  JA , Bruins  HM , Cathomas  R ,  et al. European Association of Urology muscle-invasive and metastatic bladder cancer guidelines. Published 2020. Accessed June 21, 2020.
xPharm, The Comprehensive Pharmacology Reference: bladder cancer. Science Direct. Accessed October 15, 2020.
Oxford Centre for Evidence-based Medicine: levels of evidence. Updated March 2009. Accessed June 28, 2020.
Cumberbatch  MGK , Jubber  I , Black  PC ,  et al.  Epidemiology of bladder cancer: a systematic review and contemporary update of risk factors in 2018.   Eur Urol. 2018;74(6):784-795. PubMedGoogle ScholarCrossref
Shariat  SF , Sfakianos  JP , Droller  MJ ,  et al.  The effect of age and gender on bladder cancer: a critical review of the literature.   BJU Int. 2010;105(3):300-308. doi:10.1111/j.1464-410X.2009.09076.xPubMedGoogle ScholarCrossref
Shariat  SF , Milowsky  M , Droller  MJ .  Bladder cancer in the elderly.   Urol Oncol. 2009;27(6):653-667. doi:10.1016/j.urolonc.2009.07.020PubMedGoogle ScholarCrossref
Wang  Y , Chang  Q , Li  Y .  Racial differences in urinary bladder cancer in the United States.   Sci Rep. 2018;8(1):12521. doi:10.1038/s41598-018-29987-2PubMedGoogle ScholarCrossref
Gild  P , Wankowicz  SA , Sood  A ,  et al.  Racial disparity in quality of care and overall survival among black vs. white patients with muscle-invasive bladder cancer treated with radical cystectomy.   Urol Oncol. 2018;36(10):469.e1-469.e11. doi:10.1016/j.urolonc.2018.07.012PubMedGoogle ScholarCrossref
Dobruch  J , Daneshmand  S , Fisch  M ,  et al.  Gender and bladder cancer: a collaborative review of etiology, biology, and outcomes.   Eur Urol. 2016;69(2):300-310. PubMedGoogle ScholarCrossref
Hurst  CD , Alder  O , Platt  FM ,  et al.  Genomic subtypes of non-invasive bladder cancer with distinct metabolic profile and female gender bias in KDM6A mutation frequency.   Cancer Cell. 2017;32(5):701-715. doi:10.1016/j.ccell.2017.08.005PubMedGoogle ScholarCrossref
Freedman  ND , Silverman  DT , Hollenbeck  AR ,  et al.  Association between smoking and risk of bladder cancer among men and women.   JAMA. 2011;306(7):737-745. doi:10.1001/jama.2011.1142PubMedGoogle ScholarCrossref
Coussens  LM , Werb  Z .  Inflammation and cancer.   Nature. 2002;420(6917):860-867. doi:10.1038/nature01322PubMedGoogle ScholarCrossref
Ishida  K , Hsieh  MH .  Understanding urogenital schistosomiasis-related bladder cancer: an update.   Front Med (Lausanne). 2018;5(Aug):223. doi:10.3389/fmed.2018.00223PubMedGoogle ScholarCrossref
Wallis  CJD , Mahar  AL , Choo  R ,  et al.  Second malignancies after radiotherapy for prostate cancer: systematic review and meta-analysis.   BMJ. 2016;352:i851. doi:10.1136/bmj.i851PubMedGoogle ScholarCrossref
Moschini  M , Zaffuto  E , Karakiewicz  PI ,  et al.  External beam radiotherapy increases the risk of bladder cancer when compared with radical prostatectomy in patients affected by prostate cancer.   Eur Urol. 2019;75(2):319-328. PubMedGoogle ScholarCrossref
Abern  MR , Dude  AM , Tsivian  M , Coogan  CL .  The characteristics of bladder cancer after radiotherapy for prostate cancer.   Urol Oncol. 2013;31(8):1628-1634. doi:10.1016/j.urolonc.2012.04.006PubMedGoogle ScholarCrossref
Knight  A , Askling  J , Granath  F ,  et al.  Urinary bladder cancer in Wegener’s granulomatosis: risks and relation to cyclophosphamide.   Ann Rheum Dis. 2004;63(10):1307-1311. doi:10.1136/ard.2003.019125PubMedGoogle ScholarCrossref
Warschkow  R , Güller  U , Cerny  T ,  et al.  Secondary malignancies after rectal cancer resection with and without radiation therapy: a propensity-adjusted, population-based SEER analysis.   Radiother Oncol. 2017;123(1):139-146. doi:10.1016/j.radonc.2017.02.007PubMedGoogle ScholarCrossref
Chaturvedi  AK , Engels  EA , Gilbert  ES ,  et al.  Second cancers among 104,760 survivors of cervical cancer: evaluation of long-term risk.   J Natl Cancer Inst. 2007;99(21):1634-1643. doi:10.1093/jnci/djm201PubMedGoogle ScholarCrossref
Mucci  LA , Hjelmborg  JB , Harris  JR ,  et al.  Familial risk and heritability of cancer among twins in Nordic countries.   JAMA. 2016;315(1):68-76. doi:10.1001/jama.2015.17703PubMedGoogle ScholarCrossref
Carlo  MI , Ravichandran  V , Srinavasan  P ,  et al.  Cancer susceptibility mutations in patients with urothelial malignancies.   J Clin Oncol. 2020;38(5):406-414. doi:10.1200/JCO.19.01395PubMedGoogle ScholarCrossref
Lim  A , Rao  P , Matin  SF .  Lynch syndrome and urologic malignancies: a contemporary review.   Curr Opin Urol. 2019;29(4):357-363. PubMedGoogle ScholarCrossref
Huang  D , Matin  SF , Lawrentschuk  N , Roupret  M .  Systematic review: an update on the spectrum of urological malignancies in Lynch syndrome.   Bladder Cancer. 2018;4(3):261-268. doi:10.3233/BLC-180180PubMedGoogle ScholarCrossref
Lobo  N , Shariat  SF , Guo  CC ,  et al.  What is the significance of variant histology in urothelial carcinoma?   Eur Urol Focus. 2020;6(4):653-663. PubMedGoogle ScholarCrossref
Alexandrov  LB , Nik-Zainal  S , Wedge  DC ,  et al.  Signatures of mutational processes in human cancer  [published correction appears in Nature. 2013;502 (7470):258].  Nature. 2013;500(7463):415-421. doi:10.1038/nature12477PubMedGoogle ScholarCrossref
Matulay  JT , Kamat  AM .  Advances in risk stratification of bladder cancer to guide personalized medicine.   F1000Res. 2018;7(0):1-13. doi:10.12688/f1000research.14903.1PubMedGoogle Scholar
Edwards  TJ , Dickinson  AJ , Natale  S ,  et al.  A prospective analysis of the diagnostic yield resulting from the attendance of 4020 patients at a protocol-driven haematuria clinic.   BJU Int. 2006;97(2):301-305. doi:10.1111/j.1464-410X.2006.05976.xPubMedGoogle ScholarCrossref
Xiong  Y , Li  J , Ma  S ,  et al.  A meta-analysis of narrow band imaging for the diagnosis and therapeutic outcome of non-muscle invasive bladder cancer.   PLoS One. 2017;12(2):e0170819. PubMedGoogle Scholar
Burger  M , Grossman  HB , Droller  M ,  et al.  Photodynamic diagnosis of non-muscle-invasive bladder cancer with hexaminolevulinate cystoscopy: a meta-analysis of detection and recurrence based on raw data.   Eur Urol. 2013;64(5):846-854. doi:10.1016/j.eururo.2013.03.059PubMedGoogle ScholarCrossref
Cumberbatch  MGK , Foerster  B , Catto  JWF ,  et al.  Repeat transurethral resection in non-muscle-invasive bladder cancer: a systematic review.   Eur Urol. 2018;73(6):925-933. PubMedGoogle ScholarCrossref
Chamie  K , Ballon-Landa  E , Bassett  JC ,  et al.  Quality of diagnostic staging in patients with bladder cancer: a process-outcomes link.   Cancer. 2015;121(3):379-385. doi:10.1002/cncr.29071PubMedGoogle ScholarCrossref
Luo  C , Huang  B , Wu  Y , Chen  J , Chen  L .  Use of Vesical Imaging-Reporting and Data System (VI-RADS) for detecting the muscle invasion of bladder cancer: a diagnostic meta-analysis.   Eur Radiol. 2020;30(8):4606-4614. PubMedGoogle ScholarCrossref
Faiena  I , Rosser  CJ , Chamie  K , Furuya  H .  Diagnostic biomarkers in non-muscle invasive bladder cancer.   World J Urol. 2019;37(10):2009-2016. doi:10.1007/s00345-018-2567-1PubMedGoogle ScholarCrossref
Zhang  Z , Fan  W , Deng  Q ,  et al.  The prognostic and diagnostic value of circulating tumor cells in bladder cancer and upper tract urothelial carcinoma: a meta-analysis of 30 published studies.   Oncotarget. 2017;8(35):59527-59538. doi:10.18632/oncotarget.18521PubMedGoogle ScholarCrossref
Christensen  E , Birkenkamp-Demtröder  K , Sethi  H ,  et al.  Early detection of metastatic relapse and monitoring of therapeutic efficacy by ultra-deep sequencing of plasma cell-free DNA in patients with urothelial bladder carcinoma.   J Clin Oncol. 2019;37(18):1547-1557. doi:10.1200/JCO.18.02052PubMedGoogle ScholarCrossref
Kirkali  Z , Chan  T , Manoharan  M ,  et al.  Bladder cancer: epidemiology, staging and grading, and diagnosis.   Urology. 2005;66(6)(suppl 1):4-34. PubMedGoogle ScholarCrossref
Ritch  CR , Velasquez  MC , Kwon  D ,  et al.  Use and validation of the AUA/SUO risk grouping for nonmuscle invasive bladder cancer in a contemporary cohort.   J Urol. 2020;203(3):505-511. PubMedGoogle ScholarCrossref
van den Bosch  S , Alfred Witjes  J .  Long-term cancer-specific survival in patients with high-risk, non-muscle-invasive bladder cancer and tumour progression: a systematic review.   Eur Urol. 2011;60(3):493-500. doi:10.1016/j.eururo.2011.05.045PubMedGoogle ScholarCrossref
Sylvester  RJ , Oosterlinck  W , Van Der Meijden  APM .  A single immediate postoperative instillation of chemotherapy decreases the risk of recurrence in patients with stage Ta T1 bladder cancer: a meta-analysis of published results of randomized clinical trials.   J Urol. 2004;171(6 pt 1):2186-2190. PubMedGoogle ScholarCrossref
Doherty  AP , Trendell-Smith  N , Stirling  R ,  et al.  Perivesical fat necrosis after adjuvant intravesical chemotherapy.   BJU Int. 1999;83(4):420-423. doi:10.1046/j.1464-410x.1999.00951.xPubMedGoogle ScholarCrossref
Messing  EM , Tangen  CM , Lerner  SP ,  et al.  Effect of intravesical instillation of gemcitabine vs saline immediately following resection of suspected low-grade non-muscle-invasive bladder cancer on tumor recurrence: SWOG S0337 randomized clinical trial.   JAMA. 2018;319(18):1880-1888. doi:10.1001/jama.2018.4657PubMedGoogle ScholarCrossref
Pettenati  C , Ingersoll  MA .  Mechanisms of BCG immunotherapy and its outlook for bladder cancer.   Nat Rev Urol. 2018;15(10):615-625. doi:10.1038/s41585-018-0055-4PubMedGoogle ScholarCrossref
Sylvester  RJ , van der Meijden  APM , Witjes  JA , Kurth  K .  Bacillus Calmette-Guerin versus chemotherapy for the intravesical treatment of patients with carcinoma in situ of the bladder: a meta-analysis of the published results of randomized clinical trials.   J Urol. 2005;174(1):86-91. PubMedGoogle ScholarCrossref
Brausi  M , Oddens  J , Sylvester  R ,  et al.  Side effects of bacillus Calmette-Guérin (BCG) in the treatment of intermediate- and high-risk Ta, T1 papillary carcinoma of the bladder: results of the EORTC genito-urinary cancers group randomised phase 3 study comparing one-third dose with full dose and 1 year with 3 years of maintenance BCG.   Eur Urol. 2014;65(1):69-76. PubMedGoogle ScholarCrossref
Golla  V , Lenis  AT , Faiena  I , Chamie  K .  Intravesical therapy for non-muscle invasive bladder cancer—current and future options in the age of bacillus Calmette-Guerin shortage.   Rev Urol. 2019;21(4):145-153.PubMedGoogle Scholar
Bandari  J , Maganty  A , MacLeod  LC , Davies  BJ .  Manufacturing and the market: rationalizing the shortage of bacillus Calmette-Guérin.   Eur Urol Focus. 2018;4(4):481-484. doi:10.1016/j.euf.2018.06.018PubMedGoogle ScholarCrossref
Steinberg  G , Bahnson  R , Brosman  S ,  et al.  Efficacy and safety of valrubicin for the treatment of bacillus Calmette-Guerin refractory carcinoma in situ of the bladder.   J Urol. 2000;163(3):761-767. doi:10.1016/S0022-5347(05)67799-3PubMedGoogle ScholarCrossref
Steinberg  RL , Thomas  LJ , Brooks  N ,  et al.  Multi-institution evaluation of sequential gemcitabine and docetaxel as rescue therapy for nonmuscle invasive bladder cancer.   J Urol. 2020;203(5):902-909. doi:10.1097/ju.0000000000000688PubMedGoogle ScholarCrossref
Balar  AV , Kulkarni  GS , Uchio  EM ,  et al.  Keynote 057: phase II trial of pembrolizumab (pembro) for patients (pts) with high-risk (HR) nonmuscle invasive bladder cancer (NMIBC) unresponsive to bacillus Calmette-Guérin (BCG).   J Clin Oncol. 2019;37(7 suppl):350. doi:10.1200/JCO.2019.37.7_suppl.350Google ScholarCrossref
Lerner  SP , Bajorin  DF , Dinney  CP ,  et al.  Summary and recommendations from the National Cancer Institute’s Clinical Trials Planning Meeting on Novel Therapeutics for Non-Muscle Invasive Bladder Cancer.   Bladder Cancer. 2016;2(2):165-202. PubMedGoogle ScholarCrossref
Westergren  DO , Gårdmark  T , Lindhagen  L , Chau  A , Malmström  PUA .  A nationwide, population based analysis of patients with organ confined, muscle invasive bladder cancer not receiving curative intent therapy in Sweden from 1997 to 2014.   J Urol. 2019;202(5):905-912. PubMedGoogle ScholarCrossref
Grossman  HB , Natale  RB , Tangen  CM ,  et al.  Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer.   N Engl J Med. 2003;349(9):859-866. doi:10.1056/NEJMoa022148PubMedGoogle ScholarCrossref
Yin  M , Joshi  M , Meijer  RP ,  et al.  Neoadjuvant chemotherapy for muscle-invasive bladder cancer: a systematic review and two-step meta-analysis.   Oncologist. 2016;21(6):708-715. doi:10.1634/theoncologist.2015-0440PubMedGoogle ScholarCrossref
Dash  A , Pettus  J , Herr  H ,  et al.  A role for neoadjuvant gemcitabine plus cisplatin in muscle-invasive urothelial carcinoma of the bladder: a retrospective experience.   Cancer. 2008;113(9):2471-2477. doi:10.1002/cncr.23848PubMedGoogle ScholarCrossref
von der Maase  H , Hansen  SW , Roberts  JT ,  et al.  Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study.   J Clin Oncol. 2000;18(17):3068-3077. PubMedGoogle ScholarCrossref
Zargar  H , Espiritu  PN , Fairey  AS ,  et al.  Multicenter assessment of neoadjuvant chemotherapy for muscle-invasive bladder cancer.   Eur Urol. 2015;67(2):241-249. doi:10.1016/j.eururo.2014.09.007PubMedGoogle ScholarCrossref
Galsky  MD , Hahn  NM , Rosenberg  J ,  et al.  Treatment of patients with metastatic urothelial cancer “unfit” for cisplatin-based chemotherapy.   J Clin Oncol. 2011;29(17):2432-2438. doi:10.1200/JCO.2011.34.8433PubMedGoogle ScholarCrossref
Chang  SS , Bochner  BH , Chou  R ,  et al.  Treatment of non-metastatic muscle-invasive bladder cancer: AUA/ASCO/ASTRO/SUO guideline.   J Urol. 2017;198(3):552-559. doi:10.1016/j.juro.2017.04.086PubMedGoogle ScholarCrossref
Necchi  A , Anichini  A , Raggi  D ,  et al.  Pembrolizumab as neoadjuvant therapy before radical cystectomy in patients with muscle-invasive urothelial bladder carcinoma (PURE-01): an open-label, single-arm, phase II study.   J Clin Oncol. 2018;36(34):3353-3360. doi:10.1200/JCO.18.01148PubMedGoogle ScholarCrossref
Necchi  A , Raggi  D , Gallina  A ,  et al.  Updated results of PURE-01 with preliminary activity of neoadjuvant pembrolizumab in patients with muscle-invasive bladder carcinoma with variant histologies.   Eur Urol. 2020;77(4):439-446. doi:10.1016/j.eururo.2019.10.026PubMedGoogle ScholarCrossref
Stein  JP , Lieskovsky  G , Cote  R ,  et al.  Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients.   J Clin Oncol. 2001;19(3):666-675. doi:10.1200/JCO.2001.19.3.666PubMedGoogle ScholarCrossref
Bruins  HM , Hernandez  V , Veskimae  E ,  et al.  Does the extent of lymphadenectomy impact survival after radical cystectomy: a systematic review.   Eur Urol Suppl. 2014;13(1):e118-e118b. doi:10.1016/S1569-9056(14)60119-6Google ScholarCrossref
Gschwend  JE , Heck  MM , Lehmann  J ,  et al.  Extended versus limited lymph node dissection in bladder cancer patients undergoing radical cystectomy: survival results from a prospective, randomized trial.   Eur Urol. 2019;75(4):604-611. doi:10.1016/j.eururo.2018.09.047PubMedGoogle ScholarCrossref
Nieuwenhuijzen  JA , de Vries  RR , Bex  A ,  et al.  Urinary diversions after cystectomy: the association of clinical factors, complications and functional results of four different diversions.   Eur Urol. 2008;53(4):834-842. doi:10.1016/j.eururo.2007.09.008PubMedGoogle ScholarCrossref
Bachour  K , Faiena  I , Salmasi  A ,  et al.  Trends in urinary diversion after radical cystectomy for urothelial carcinoma.   World J Urol. 2018;36(3):409-416. doi:10.1007/s00345-017-2169-3PubMedGoogle ScholarCrossref
Shabsigh  A , Korets  R , Vora  KC ,  et al.  Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology.   Eur Urol. 2009;55(1):164-174. doi:10.1016/j.eururo.2008.07.031PubMedGoogle ScholarCrossref
Quek  ML , Stein  JP , Daneshmand  S ,  et al.  A critical analysis of perioperative mortality from radical cystectomy.   J Urol. 2006;175(3, pt 1):886-889. doi:10.1016/S0022-5347(05)00421-0PubMedGoogle ScholarCrossref
Hu  M , Jacobs  BL , Montgomery  JS ,  et al.  Sharpening the focus on causes and timing of readmission after radical cystectomy for bladder cancer.   Cancer. 2014;120(9):1409-1416. doi:10.1002/cncr.28586PubMedGoogle ScholarCrossref
Gerharz  EW , Turner  WH , Kälble  T , Woodhouse  CRJ .  Metabolic and functional consequences of urinary reconstruction with bowel.   BJU Int. 2003;91(2):143-149. doi:10.1046/j.1464-410X.2003.04000.xPubMedGoogle ScholarCrossref
Williams  SB , Shan  Y , Jazzar  U ,  et al.  Comparing survival outcomes and costs associated with radical cystectomy and trimodal therapy for older adults with muscle-invasive bladder cancer.   JAMA Surg. 2018;153(10):881-889. doi:10.1001/jamasurg.2018.1680PubMedGoogle ScholarCrossref
Cahn  DB , Handorf  EA , Ghiraldi  EM ,  et al.  Contemporary use trends and survival outcomes in patients undergoing radical cystectomy or bladder-preservation therapy for muscle-invasive bladder cancer.   Cancer. 2017;123(22):4337-4345. doi:10.1002/cncr.30900PubMedGoogle ScholarCrossref
Ploussard  G , Daneshmand  S , Efstathiou  JA ,  et al.  Critical analysis of bladder sparing with trimodal therapy in muscle-invasive bladder cancer: a systematic review.   Eur Urol. 2014;66(1):120-137. PubMedGoogle ScholarCrossref
Knoedler  JJ , Boorjian  SA , Kim  SP ,  et al.  Does partial cystectomy compromise oncologic outcomes for patients with bladder cancer compared to radical cystectomy? a matched case-control analysis.   J Urol. 2012;188(4):1115-1119. doi:10.1016/j.juro.2012.06.029PubMedGoogle ScholarCrossref
Sternberg  CN , de Mulder  P , Schornagel  JH ,  et al.  Seven year update of an EORTC phase III trial of high-dose intensity M-VAC chemotherapy and G-CSF versus classic M-VAC in advanced urothelial tract tumours.   Eur J Cancer. 2006;42(1):50-54. doi:10.1016/j.ejca.2005.08.032PubMedGoogle ScholarCrossref
von der Maase  H , Hansen  SW , Roberts  JT ,  et al.  Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study.   J Clin Oncol. 2000;18(17):3068-3077. doi:10.1200/JCO.2000.18.17.3068PubMedGoogle ScholarCrossref
Sternberg  CN , Skoneczna  I , Kerst  JM ,  et al.  Immediate versus deferred chemotherapy after radical cystectomy in patients with pT3-pT4 or N+ M0 urothelial carcinoma of the bladder (EORTC 30994): an intergroup, open-label, randomised phase 3 trial.   Lancet Oncol. 2015;16(1):76-86. doi:10.1016/S1470-2045(14)71160-XPubMedGoogle ScholarCrossref
Bellmunt  J , de Wit  R , Vaughn  DJ ,  et al; KEYNOTE-045 Investigators.  Pembrolizumab as second-line therapy for advanced urothelial carcinoma.   N Engl J Med. 2017;376(11):1015-1026. doi:10.1056/NEJMoa1613683PubMedGoogle ScholarCrossref
Balar  AV , Castellano  D , O’Donnell  PH ,  et al.  First-line pembrolizumab in cisplatin-ineligible patients with locally advanced and unresectable or metastatic urothelial cancer (KEYNOTE-052): a multicentre, single-arm, phase 2 study.   Lancet Oncol. 2017;18(11):1483-1492. doi:10.1016/S1470-2045(17)30616-2PubMedGoogle ScholarCrossref
Powles  T , Durán  I , van der Heijden  MS ,  et al.  Atezolizumab versus chemotherapy in patients with platinum-treated locally advanced or metastatic urothelial carcinoma (IMvigor211): a multicentre, open-label, phase 3 randomised controlled trial.   Lancet. 2018;391(10122):748-757. doi:10.1016/S0140-6736(17)33297-XPubMedGoogle ScholarCrossref
Sharma  P , Retz  M , Siefker-Radtke  A ,  et al.  Nivolumab in metastatic urothelial carcinoma after platinum therapy (CheckMate 275): a multicentre, single-arm, phase 2 trial.   Lancet Oncol. 2017;18(3):312-322. doi:10.1016/S1470-2045(17)30065-7PubMedGoogle ScholarCrossref
Powles  T , O’Donnell  PH , Massard  C ,  et al.  Efficacy and safety of durvalumab in locally advanced or metastatic urothelial carcinoma: updated results from a phase 1/2 open-label study.   JAMA Oncol. 2017;3(9):e172411. doi:10.1001/jamaoncol.2017.2411PubMedGoogle Scholar
Apolo  AB , Infante  JR , Balmanoukian  A ,  et al.  Avelumab, an anti-programmed death-ligand 1 antibody, in patients with refractory metastatic urothelial carcinoma: results from a multicenter, phase Ib study.   J Clin Oncol. 2017;35(19):2117-2124. doi:10.1200/JCO.2016.71.6795PubMedGoogle ScholarCrossref
Loriot  Y , Necchi  A , Park  SH ,  et al; BLC2001 Study Group.  Erdafitinib in locally advanced or metastatic urothelial carcinoma.   N Engl J Med. 2019;381(4):338-348. doi:10.1056/NEJMoa1817323PubMedGoogle ScholarCrossref
Rosenberg  JE , O’Donnell  PH , Balar  AV ,  et al.  Pivotal trial of enfortumab vedotin in urothelial carcinoma after platinum and anti-programmed death 1/programmed death ligand 1 therapy.   J Clin Oncol. 2019;37(29):2592-2600. PubMedGoogle ScholarCrossref
Rosenberg  JE , Flaig  TW , Friedlander  TW ,  et al.  Study EV-103: preliminary durability results of enfortumab vedotin plus pembrolizumab for locally advanced or metastatic urothelial carcinoma.   J Clin Oncol. 2020;38(6 suppl):441. doi:10.1200/jco.2020.38.6_suppl.441Google ScholarCrossref
Tagawa  ST , Balar  A , Petrylak  DP ,  et al.  Initial results from TROPHY-U-01: a phase II open-label study of sacituzumab govitecan in patients (Pts) with metastatic urothelial cancer (mUC) after failure of platinum-based regimens (PLT) or immunotherapy.   Ann Oncol. 2019;30(suppl 5):v890-v891. doi:10.1093/annonc/mdz394.049Google ScholarCrossref
Freshwater  T , Li  H , Valiathan  C ,  et al.  Systematic literature review and meta-analysis of response to first-line therapies for advanced/metastatic urothelial cancer patients who are cisplatin ineligible.   Am J Clin Oncol. 2019;42(10):802-809. doi:10.1097/COC.0000000000000585PubMedGoogle ScholarCrossref
Donin  NM , Lenis  AT , Holden  S ,  et al.  Immunotherapy for the treatment of urothelial carcinoma.   J Urol. 2017;197(1):14-22. doi:10.1016/j.juro.2016.02.3005PubMedGoogle ScholarCrossref
Robinson  BD , Vlachostergios  PJ , Bhinder  B ,  et al.  Upper tract urothelial carcinoma has a luminal-papillary T-cell depleted contexture and activated FGFR3 signaling.   Nat Commun. 2019;10(1):2977. doi:10.1038/s41467-019-10873-yPubMedGoogle ScholarCrossref
Sarfaty  M , Rosenberg  JE .  Antibody-drug conjugates in urothelial carcinomas.   Curr Oncol Rep. 2020;22(2):13. doi:10.1007/s11912-020-0879-yPubMedGoogle ScholarCrossref
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