Future directions for antibody-drug conjugates in urothelial cancer.

INTRODUCTION

Urothelial carcinoma (UC) is a highly aggressive malignancy that has traditionally been treated with platinum-based chemotherapy. In recent years, the therapeutic landscape has undergone substantial transformation with the advent of precision oncology, particularly through the introduction of immune checkpoint inhibitors, targeted agents, and antibody-drug conjugates (ADCs).

AREAS COVERED: We searched MEDLINE (via PubMed), Embase, and ClinicalTrials.gov and reviewed practice guidelines from ASCO, ESMO, AIOM, and EAU in order to describe the current landscape of ADC-based therapy in UC.

EXPERT OPINION: ADCs are rising as a cornerstone in UC, but important challenges remain. Future perspectives point toward the development of combination strategies and next-generation ADCs, designed to overcome resistance, minimize toxicity, and enhance selectivity.