Platinum-based chemotherapy has long been the standard treatment for metastatic bladder cancer and for muscle-invasive bladder cancer where neoadjuvant chemotherapy is delivered prior to surgery. However, the landscape began to shift with the development of immune checkpoint inhibitors, which release "the brakes" on immune cells, freeing them to attack cancer cells.
When combined with chemotherapy and new drug formulations, like the antibody-drug conjugate enfortumab vedotin, which the FDA approved in 2019 for the treatment of advanced bladder cancer, these treatments are notably more effective than chemotherapy alone.