Development of target specific agents for bladder cancer

Introduction: There has been a paucity of new therapies developed for the treatment of advanced urothelial cancer due to a convergence of factors including a low prioritization of the disease by industry, therapeutic nihilism, and a limited understanding of the molecular pathogenesis and relevant therapeutic targets. Areas covered: Herein, we review contemporary clinical trials in metastatic urothelial cancer. The review focuses primary on therapeutics directed against somatic genomic alterations, immune checkpoints, and tumor-specific antigen which may serve to selectively deliver cytotoxic payloads (i.e., antibody drug conjugates). Expert commentary: Novel therapeutic approaches have finally established proof of concept in patients with metastatic urothelial cancer. The next few years will witness an expansion of the standard armamentarium and lead to improved outcomes for those suffering with this difficult disease.