REVIEW article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1604395
This article is part of the Research TopicStreamlining Drug Approvals: Addressing Policy Challenges in Genitourinary OncologyView all articles
Changing landscape of first-line treatment for locally advanced or metastatic urothelial carcinoma: the progression from platinum-based chemotherapy to platinum-free therapy
Provisionally accepted
- 1Jilin University, Changchun, China
- 2Department of Cancer Center, The First Hospital of Jilin University, Changchun, Hebei Province, China
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Urothelial carcinoma (UC) represents the most common pathological type of bladder cancer. For patients with locally advanced or metastatic UC (la/m UC), the standard of care with platinum-based chemotherapy as the cornerstone has greatly improved the survival time. Although the platinumcontaining regimens have been established as the first-line therapeutic approach for la/m UC and demonstrate high initial response rates, most patients experience disease recurrence or metastasis shortly after treatment cessation, compounded by the inherent toxicity associated with platinum agents, which collectively pose substantial challenges to long-term patient survival. Moreover, some patients are ineligible to receive a platinum containing therapy, which greatly affects their potential possible benefit. With the success of the EV-302 study, the combination of enfortumab-vedotin (EV) and pembrolizumab has supplanted chemotherapy as the current standard of care for the first-line treatment of la/m UC, thus initiating a treatment paradigm of platinum-free for the first-line treatment of la/m UC. In recent years, the treatment landscape of la/m UC has witnessed remarkable shifts, evolving from traditional chemotherapy to the emerging "chemotherapy-free (platinum-free)" strategy. This article provides a comprehensive review of the historical development and outlook of first-line treatment strategies for la/m UC, including the role of chemotherapy, the rise of platinumfree and its clinical applications. Through this in -depth exploration, the article endeavors to offer readers a holistic understanding of the present treatment panorama for la/m UC, furnishing them with profound insights into the transformative trajectory and emerging trends within la/m UC treatment strategies.
Keywords: Locally advanced1, Metastatic2 Urothelial carcinoma (UC)3, first-line therapy4, Platinum-free5, Landscape6
Received: 01 Apr 2025; Accepted: 10 Jun 2025.
Copyright: © 2025 Liu, Chen, Yin, Cong and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xiaofeng Cong, Department of Cancer Center, The First Hospital of Jilin University, Changchun, Hebei Province, China
Zi-Ling Liu, Department of Cancer Center, The First Hospital of Jilin University, Changchun, Hebei Province, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.