Advanced urothelial cancer treatment: immunotherapy, ADCs and HER2

Confirm that the discussion concerns advanced urothelial cancer

Urothelial cancer can begin in the bladder or in the lining of the upper urinary tract. Treatment for disease limited to the bladder differs from treatment for unresectable locally advanced or metastatic disease. Ask the team to state the current extent and whether a local curative approach remains possible.

This guide focuses on advanced disease. Bring the pathology, imaging and all previous treatment details, including surgery, bladder instillations, chemotherapy and immunotherapy. The sequence matters because an option used before surgery may affect what is appropriate when the cancer later spreads.

Sources and references: [1]

Assess the factors that shape the first regimen

Kidney function, hearing, nerve symptoms and general fitness help determine whether cisplatin-based chemotherapy is suitable. Diabetes, skin problems and pre-existing neuropathy can also matter when discussing antibody-drug conjugates. Tell the team how the illness affects walking, eating and daily activities.

Ask whether additional tumor testing would change the choice. A molecular or HER2 report should include the testing method and the exact result. Keeping those details together helps the clinician compare an established regimen with a biomarker-selected option or a clinical trial.

Sources and references: [1] [2] [3]

One established combination: enfortumab with pembrolizumab

Enfortumab vedotin is an antibody-drug conjugate, or ADC, that carries a cell-killing medicine to a target on cancer cells. In the United States it is approved with pembrolizumab for locally advanced or metastatic urothelial cancer. The EV-302 trial showed improved outcomes compared with platinum chemotherapy in previously untreated advanced disease.

If this combination is proposed, ask about skin reactions, blood sugar, nerve symptoms and immune-related effects. The monitoring plan should specify what to report between infusions. For Shanghai care, confirm the local indication and supply pathway as part of the consultation.

Sources and references: [2]

What disitamab vedotin adds to the China discussion

Disitamab vedotin is a HER2-directed ADC. In April 2026, China approved its combination with toripalimab for HER2-expressing locally advanced or metastatic urothelial cancer, with expression defined as an immunohistochemistry score of 1+, 2+ or 3+.

The randomized RC48-C016 trial studied previously untreated advanced disease with that HER2 expression range and compared the combination with gemcitabine plus platinum chemotherapy. It found improved progression-free and overall survival outcomes. Ask the reviewing team to match your HER2 report and treatment history to the current Chinese prescribing information.

Sources and references: [3] [4]

Compare the whole sequence if chemotherapy is chosen

Platinum chemotherapy remains relevant in some treatment pathways. If the cancer is controlled after the initial course, maintenance immunotherapy may be discussed in an appropriate setting. A later-line plan depends on which chemotherapy, checkpoint inhibitor or ADC has already been used.

Ask the oncologist to sketch the intended first phase, reassessment and possible maintenance step. If the tumor progresses, further molecular review can identify selected targeted options or trials. That sequence is more useful than comparing drug names without knowing when each would be used.

Sources and references: [1]

Prepare for overlapping treatment effects

An ADC and an immune medicine can cause different types of toxicity in the same patient. Numbness, tingling, new weakness, rash and fatigue need attention, while diarrhea, breathlessness or marked changes in energy can also signal immune-related inflammation.

Ask for a medicine-specific contact sheet and bring it when seeking care elsewhere. Existing neuropathy, diabetes or autoimmune disease should be discussed before treatment starts. Dose changes, supportive treatment or a pause may be needed to keep treatment tolerable; report symptoms while they are still manageable.

Sources and references: [2] [5] [6]

Keep urinary symptoms and daily support in the plan

Bleeding, pain or obstruction may need local management while systemic treatment is organized. Ask whether a urology review, drainage procedure or radiation assessment is needed for a symptom that is limiting daily life. Fever with urinary symptoms or an inability to pass urine calls for prompt local assessment.

Record changes in urine, pain, appetite and activity between visits. These observations complement the scans used to assess treatment. Before international travel, clarify where blood tests and urgent urological care will be available and how your local doctor can reach the treating team.

Sources and references: [1]

Arrange a biomarker-focused consultation

Fudan University Shanghai Cancer Center has urological oncology services. A review can compare the next systemic regimen and clarify whether HER2-directed treatment is relevant. Specific drug supply and appointment arrangements need to be established with the receiving service.

Send EastMedGo the pathology, HER2 and molecular reports, scans, kidney-function results and dated treatment list. Include current neuropathy or urinary problems. We can organize the records and coordinate a consultation request that addresses the regimen, monitoring and practical treatment schedule before you plan the journey.

Sources and references: [7]

Common questions