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Review Open Access

Targeted therapies for urothelial carcinoma: From FGFR inhibitors to next‑generation antibody-drug conjugates (Review)

  • Authors:
    • Jinping Du
    • Hao Shen
    • Tongwei Zeng
    • Wei Liu
    • Yongqiang Xie
  • View Affiliations / Copyright

    Affiliations: Gansu University of Chinese Medicine, Lanzhou, Gansu 730000, P.R. China
    Copyright: © Du et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 28
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    Published online on: December 22, 2025
       https://doi.org/10.3892/ijo.2025.5841
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Abstract

Treatment of urothelial carcinoma (UC), particularly in metastatic or cisplatin‑ineligible patients, remains challenging because of limited durable responses to conventional chemotherapy and immune checkpoint inhibitors. Recent advances in targeted therapies, including FGFR inhibitors (for example, erdafitinib) and antibody‑drug conjugates (ADCs) targeting Nectin‑4 (enfortumab vedotin) and HER2 (disitamab vedotin), have reshaped treatment paradigms. FGFR3 alterations, which are present in 20‑40% of patients with advanced UC, predict sensitivity to FGFR tyrosine kinase inhibitors, whereas ADCs demonstrate efficacy across biomarker‑selected and unselected populations. However, clinical implementation is complicated by resistance mechanisms, such as kinase switching, phenotypic plasticity and tumor microenvironment interactions, as well as biomarker heterogeneity. The present review synthesizes current evidence on molecularly guided therapies, contrasts resistance mechanisms between FGFR inhibitors and ADCs, and evaluates strategies to overcome therapeutic limitations. By integrating translational insights and emerging preclinical data, it was aimed to provide a roadmap for optimizing biomarker‑driven approaches, novel combinations and next‑generation agents for the treatment of UC.
View Figures

Figure 1

Molecular Landscape of UC. Key
molecular targets and pathways discussed in the review are visually
summarized. The molecular landscape of UC with the current targeted
therapies is integrated, highlighting the pathways involved and the
main targets. The image was designed using Figdraw.com. UC, urothelial carcinoma; FGFR,
fibroblast growth factor receptor.

Figure 2

Mechanisms of action and resistance
pathways of FGFR-TKIs and ADCs in urothelial carcinoma. The image
was designed using Figdraw.com. FGFR, fibroblast
growth factor receptor; TKIs, tyrosine kinase inhibitors; ADCs,
antibody-drug conjugates; EMT, epithelial-mesenchymal
transition.

Figure 3

Schematic of convergent resistance
pathways and novel overcoming strategies for FGFR inhibitors and
ADCs in UC. This figure illustrates the shared and target-specific
resistance mechanisms to FGFR-TKIs and ADCs in UC, alongside
emerging therapeutic strategies to circumvent resistance. The image
was designed using Figdraw.com. FGFR, fibroblast
growth factor receptor; ADCs, antibody-drug conjugates; UC,
urothelial carcinoma.
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Spandidos Publications style
Du J, Shen H, Zeng T, Liu W and Xie Y: Targeted therapies for urothelial carcinoma: From FGFR inhibitors to next‑generation antibody-drug conjugates (Review). Int J Oncol 68: 28, 2026.
APA
Du, J., Shen, H., Zeng, T., Liu, W., & Xie, Y. (2026). Targeted therapies for urothelial carcinoma: From FGFR inhibitors to next‑generation antibody-drug conjugates (Review). International Journal of Oncology, 68, 28. https://doi.org/10.3892/ijo.2025.5841
MLA
Du, J., Shen, H., Zeng, T., Liu, W., Xie, Y."Targeted therapies for urothelial carcinoma: From FGFR inhibitors to next‑generation antibody-drug conjugates (Review)". International Journal of Oncology 68.2 (2026): 28.
Chicago
Du, J., Shen, H., Zeng, T., Liu, W., Xie, Y."Targeted therapies for urothelial carcinoma: From FGFR inhibitors to next‑generation antibody-drug conjugates (Review)". International Journal of Oncology 68, no. 2 (2026): 28. https://doi.org/10.3892/ijo.2025.5841
Copy and paste a formatted citation
x
Spandidos Publications style
Du J, Shen H, Zeng T, Liu W and Xie Y: Targeted therapies for urothelial carcinoma: From FGFR inhibitors to next‑generation antibody-drug conjugates (Review). Int J Oncol 68: 28, 2026.
APA
Du, J., Shen, H., Zeng, T., Liu, W., & Xie, Y. (2026). Targeted therapies for urothelial carcinoma: From FGFR inhibitors to next‑generation antibody-drug conjugates (Review). International Journal of Oncology, 68, 28. https://doi.org/10.3892/ijo.2025.5841
MLA
Du, J., Shen, H., Zeng, T., Liu, W., Xie, Y."Targeted therapies for urothelial carcinoma: From FGFR inhibitors to next‑generation antibody-drug conjugates (Review)". International Journal of Oncology 68.2 (2026): 28.
Chicago
Du, J., Shen, H., Zeng, T., Liu, W., Xie, Y."Targeted therapies for urothelial carcinoma: From FGFR inhibitors to next‑generation antibody-drug conjugates (Review)". International Journal of Oncology 68, no. 2 (2026): 28. https://doi.org/10.3892/ijo.2025.5841
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