Global clinical trial landscape and therapeutic trends in bladder cancer: a systematic analysis.

Bladder cancer (BCa) remains a major oncological challenge worldwide, characterized by high recurrence rate, treatment resistance and variable clinical outcomes. As of 25 April 2025, the assessment of 2899 clinical trials registered in the INFORMA database revealed the main trends affecting this field. Since 2014, the number of BCa trials has increased sharply, and since 2018, it has tended to stabilize. The United States leads the world in research with over 1000 trials. Immunotherapy, especially PD-1/PD-L1 checkpoint blockade and cytotoxic chemotherapy, dominate the treatment field, while targeted therapy has also accelerated its follow-up. Antibody-drug conjugates (ADCs) and Bladder preservation therapy (BPT) have become increasingly prominent, reflecting a shift towards patient-centeredness and individualized and organ-preserving strategies. Driven by regulatory innovation and technological progress, the trial cycle has been accelerated, indicating a transformation in the clinical development process. These findings emphasize the importance of precise oncology and multidisciplinary team management in contemporary BCa treatment paradigms.