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Back to the Bladder & urothelial cancer hub →40 questions · 6 red cards

The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask.

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Decisions you may face

12 with more than one option · full decision page →

One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.

NMIBC3 MIBC2 Metastatic2 Diagnosis and surveillance2 Low / intermediate-risk NMIBC2 High-risk NMIBC, BCG-naive2 BCG-unresponsive NMIBC (CIS ± papillary)5 Muscle-invasive, cisplatin-eligible4 Muscle-invasive, cisplatin-ineligible2 After cystectomy (no perioperative IO)3 Metastatic, first line4 Metastatic, later lines5

Red cards

From the labels and guidelines behind the standard of care. Your team's thresholds win.

Emergency services now
Hypophysitis or adrenal crisis
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
Atezolizumab Avelumab Durvalumab Nivolumab Pembrolizumab source
Emergency services now
Skin reaction
Blisters, peeling, or sores in the mouth or eyes with a rash. Enfortumab vedotin carries a boxed warning for Stevens-Johnson syndrome and toxic epidermal necrolysis, mostly in the first cycle.
AK146D1 Disitamab vedotin Enfortumab vedotin Izalontamab brengitecan Sacituzumab tirumotecan source
Emergency services now
Fainting or palpitations
Fainting, near-fainting, or an irregular or racing heartbeat; several kinase inhibitors prolong the QT interval and the labels require ECG and electrolyte monitoring.
Erdafitinib source
Check before combining
Food and drink: Enfortumab vedotin
Hyperglycaemia: hold if glucose above 13.9 mmol/L (250 mg/dL).
Enfortumab vedotin source
Check before combining
Food and drink: Pembrolizumab
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
Pembrolizumab source
Good to know
Immune-related endocrinopathies (thyroiditis, hypophysitis)
Immunotherapy can attack hormone-producing glands: most often the thyroid (usually ending in an under-active thyroid needing lifelong tablets), and less often the pituitary (hypophysitis) or adrenal glands, which can be life-threatening if missed.
Nivolumab Pembrolizumab source

See all on the product pages:AK146D1 Atezolizumab Avelumab Disitamab vedotin Durvalumab Enfortumab vedotin Erdafitinib Izalontamab brengitecan Nivolumab Pembrolizumab Sacituzumab tirumotecan·Printable cards in the navigator

Questions to ask

Bring to your appointment

Questions to ask your oncologist about Bladder & urothelial cancer

Generated from this cancer's standard of care, biomarkers, and pipeline · 40 questions

Newly diagnosed

What is my exact diagnosis, stage, and grade, and which tests established them?
Why: Everything else follows from an accurate stage and subtype.
Which biomarkers have been tested on my tumour (for example FGFR3, PD-L1, HER2, Nectin-4, ctDNA), and what were the results?
Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
Which subtype is my cancer, and does that change the recommended treatment?
Why: Recognised subtypes for this cancer include Non-muscle-invasive, Muscle-invasive, Upper-tract urothelial carcinoma.
Is germline (inherited) genetic testing recommended for me or my family?
Why: Inherited variants can change treatment and matter for relatives.

NMIBC

For my situation (nmibc), which of the standard options do you recommend and why?
Why: Guideline options include: Non-muscle-invasive: transurethral resection (TURBT) then intravesical BCG; novel intravesical agents for BCG-unresponsive disease; durvalumab + BCG for high-risk disease (2026).
Am I a candidate for Durvalumab, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

MIBC

For my situation (mibc), which of the standard options do you recommend and why?
Why: Guideline options include: Muscle-invasive: neoadjuvant chemotherapy ± durvalumab → radical cystectomy → ctDNA-guided atezolizumab or nivolumab; perioperative enfortumab vedotin + pembrolizumab for cisplatin-ineligible patients (EV-303), with EV-304 positive in cisplatin-eligible patients.
Am I a candidate for Atezolizumab, Signatera, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of IMvigor011 and EV-303 / KEYNOTE-905 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Metastatic

For my situation (metastatic), which of the standard options do you recommend and why?
Why: Guideline options include: Enfortumab vedotin (an antibody-drug conjugate) + pembrolizumab (immunotherapy); erdafitinib for FGFR3 alterations; platinum chemotherapy + nivolumab.
Am I a candidate for Enfortumab vedotin, Pembrolizumab, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of EV-302 / KEYNOTE-A39 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Diagnosis and surveillance

For my situation (diagnosis and surveillance), which of the standard options do you recommend and why?
Why: Guideline options include: Cystoscopy (white or blue light) and TURBT with muscle in the specimen; re-resection for T1; CT urography; urine cytology; surveillance cystoscopy every 3-12 months by risk.

Low / intermediate-risk NMIBC

For my situation (low / intermediate-risk nmibc), which of the standard options do you recommend and why?
Why: Guideline options include: TURBT with single immediate intravesical chemotherapy instillation; intermediate risk adds 1 year of intravesical chemotherapy (gemcitabine/mitomycin) or BCG.

High-risk NMIBC, BCG-naive

For my situation (high-risk nmibc, bcg-naive), which of the standard options do you recommend and why?
Why: Guideline options include: TURBT then BCG induction and 1-3 years maintenance; durvalumab + BCG approved May 2026 (POTOMAC); radical cystectomy for very high-risk (T1 + CIS, variant histology).
Am I a candidate for Intravesical BCG, Durvalumab, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of POTOMAC apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

BCG-unresponsive NMIBC (CIS ± papillary)

For my situation (bcg-unresponsive nmibc (cis ± papillary)), which of the standard options do you recommend and why?
Why: Guideline options include: Radical cystectomy remains the oncologic gold standard; bladder-sparing options: TAR-200 (Inlexzo, 2025), N-803 + BCG (Anktiva, 2024), nadofaragene firadenovec (2022), pembrolizumab (2020); cretostimogene in registration.
Am I a candidate for Gemcitabine intravesical system (TAR-200), Nogapendekin alfa inbakicept, Nadofaragene firadenovec or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of SunRISe-1 and BOND-003 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Muscle-invasive, cisplatin-eligible

For my situation (muscle-invasive, cisplatin-eligible), which of the standard options do you recommend and why?
Why: Guideline options include: Perioperative EV + pembrolizumab (EV-304, positive 2025; filing) or neoadjuvant durvalumab + gemcitabine-cisplatin with adjuvant durvalumab (NIAGARA, approved 2025), then radical cystectomy with lymph node dissection; trimodality bladder preservation (TURBT + chemoradiation) for selected patients.
Am I a candidate for Enfortumab vedotin, Pembrolizumab, Durvalumab, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of EV-304 / KEYNOTE-B15 and NIAGARA apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Muscle-invasive, cisplatin-ineligible

For my situation (muscle-invasive, cisplatin-ineligible), which of the standard options do you recommend and why?
Why: Guideline options include: Perioperative EV + pembrolizumab with cystectomy (EV-303, approved Nov 2025); or cystectomy alone / chemoradiation.
Am I a candidate for Enfortumab vedotin, Pembrolizumab, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of EV-303 / KEYNOTE-905 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

After cystectomy (no perioperative IO)

For my situation (after cystectomy (no perioperative io)), which of the standard options do you recommend and why?
Why: Guideline options include: Adjuvant nivolumab for high-risk pathology (CheckMate 274); or ctDNA-guided adjuvant atezolizumab (IMvigor011, approved 2026).
Am I a candidate for Nivolumab, Atezolizumab, Signatera, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of CheckMate 274 and IMvigor011 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Metastatic, first line

For my situation (metastatic, first line), which of the standard options do you recommend and why?
Why: Guideline options include: Enfortumab vedotin + pembrolizumab (EV-302); if contraindicated, platinum-gemcitabine followed by avelumab maintenance (JAVELIN Bladder 100) or nivolumab + gemcitabine-cisplatin (CheckMate 901).
Am I a candidate for Enfortumab vedotin, Pembrolizumab, Avelumab or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of EV-302 / KEYNOTE-A39 and JAVELIN Bladder 100 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Metastatic, later lines

For my situation (metastatic, later lines), which of the standard options do you recommend and why?
Why: Guideline options include: Erdafitinib if FGFR3-altered (THOR); platinum chemotherapy if not yet given; disitamab vedotin ± toripalimab (HER2, China); sacituzumab govitecan (US indication withdrawn 2024); trials of TROP2/HER2/bispecific ADCs and sac-TMT.
Am I a candidate for Erdafitinib, Disitamab vedotin, Sacituzumab tirumotecan or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of THOR apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Any stage

Are there clinical trials I could join, for example of Izalontamab brengitecan, AK146D1, Disitamab vedotin, Intismeran autogene?
Why: Trials are how the next standard of care is set; asking early keeps options open.
Would a second opinion at a high-volume centre change anything, and can you help arrange it?
Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
Why: Supportive care improves quality of life and helps patients complete treatment.
I read that “BCG supply”. How does that affect my plan?
Why: Open problems are where trials and second opinions matter most.
I read that “Bladder preservation strategies”. How does that affect my plan?
Why: Open problems are where trials and second opinions matter most.

Newly diagnosed? Read the first 60 days with Bladder & urothelial cancer, then print the one-page appointment sheet with room for the answers.

Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.

Model panel1 model

Machine commentary by named AI models on a date, not clinical review. Claims are tied to the record's own sources; check them before relying on anything here.

FableAnthropic · v5.12026-09-17low confidence

The epidemiology (smoking, non-muscle-invasive share, burden figures) and the metastatic standard of care (EV + pembrolizumab preferred first line, erdafitinib as the sole targeted agent) are consistent with the record's listed PDQ, Wikipedia and NCCN sources, and the May 2026 durvalumab + BCG approval is backed by the record's own FDA link. Most of the record's distinctive claims, however, concern 2025-2026 approvals and trial readouts (IMvigor011, EV-303, EV-304, TAR-200, cretostimogene filing) that none of the five cited sources documents, so they cannot be checked here. Internal problems include a four-versus-five count of BCG-unresponsive options, duplicated history and biomarker entries, an overbroad 'first new bladder drug in 30 years' claim for atezolizumab, an MIBC entry that implies stacking adjuvant IO on perioperative durvalumab, and the absence of any standard-of-care entry for upper-tract urothelial carcinoma despite it being the record's alternate name.

Right 3Disputed 2Missing 1Unclear 2Show verdicts

Right
Smoking causes about half of cases; three quarters present as non-muscle-invasive disease.
The listed Wikipedia and PDQ pages give tobacco as the leading risk factor responsible for roughly half of cases and put the non-muscle-invasive share at about 70-75% at diagnosis, consistent with the record's summary and subtypes.
Wikipedia
Right
Erdafitinib remains the only targeted drug, for FGFR3-altered tumours after immunotherapy; enfortumab vedotin + pembrolizumab is the NCCN category 1 preferred first-line metastatic regimen.
The NCCN metastatic bladder cancer summary listed as a source positions EV + pembrolizumab as preferred first-line therapy and erdafitinib as the only biomarker-selected targeted agent (FGFR3 alterations) after prior systemic therapy. The 'esmoMcbs' field cites EV-301 and TROPHY-U-01 rather than EV-302, which does not match the setting described.
NCCN Guidelines: Bladder Cancer (Metastatic)
Right
Durvalumab + BCG became the first systemic immunotherapy in BCG-naive disease (POTOMAC, May 2026).
The record's own FDA approval link is labelled as the May 2026 durvalumab + BCG approval in high-risk NMIBC, which matches the claim. The panel cannot verify the page content beyond its label, and the linked NCCN NMIBC guideline entry ('durvalumab + BCG newly approved') gives no category, so guideline standing is not settled by the sources.
FDA: durvalumab + BCG approval (May 2026)
Unclear
In 2026 the first blood-test-guided drug approval: adjuvant atezolizumab for ctDNA-positive MIBC (IMvigor011, 2026); EV-303 approved November 2025; EV-304 positive December 2025; TAR-200 approved September 2025.
None of the five listed sources documents these 2025-2026 regulatory events or the IMvigor011 approval. The claims rest on linked trial and paper records rather than on cited external sources, so they cannot be checked from the record's own sources. The 'first ctDNA-guided approval in any cancer' superlative is also unsupported by any listed source.
NCI PDQ: bladder cancer treatment
Disputed
Atezolizumab: first new bladder drug in 30 years (2016).
The history entry drops the usual qualifier 'for advanced/metastatic disease'. Valrubicin (1998) and BCG (1990) were approved for bladder cancer within that window, as the record's own linked drug records note. The claim should be narrowed to advanced urothelial cancer; the listed sources do not carry the superlative as written.
NCI PDQ: bladder cancer treatment
Disputed
The BCG-unresponsive population gained four bladder-sparing options (summary) versus 'Five bladder-sparing options for BCG-unresponsive disease' (stateOfArt).
The record contradicts itself: the summary counts four approved options and treats cretostimogene as still filing, while stateOfArt counts five by including the unapproved oncolytic virus. The NCCN NMIBC guideline entry in the record labels intravesical options category 2A with cystectomy preferred, so the count of approved options should be made consistent. Duplicate history entries (1976, 2016, 2023, 2026) and duplicated biomarker entries also need consolidation.
NCCN Guidelines: Bladder Cancer (NMIBC)
Missing
Upper-tract urothelial carcinoma (renal pelvis, ureter; ~5-10%) is listed as a subtype and named in the record's aka field, but no standard-of-care entry covers it.
The record's alternate name is the PDQ title for renal pelvis and ureter cancer, and PDQ describes nephroureterectomy, kidney-sparing endoscopic management and adjuvant chemotherapy for upper-tract disease. The record has standardOfCare entries only for bladder settings, and mentions upper-tract disease only as under-represented in trials.
NCI PDQ: bladder cancer treatment
Unclear
MIBC: Neoadjuvant chemo ± durvalumab → cystectomy → ctDNA-guided atezolizumab or nivolumab.
This compressed entry implies adjuvant atezolizumab or nivolumab follows perioperative durvalumab, whereas the record's later entry correctly restricts adjuvant IO to patients with 'no perioperative IO'. Neither listed NCCN source addresses sequencing adjuvant checkpoint therapy after perioperative durvalumab, so the entry should be aligned with the more careful one.
NCCN Guidelines: Bladder Cancer (NMIBC)

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ProvenanceLast edited 2026-09-18 · Jude Gomila · Fix issues 42, 39, 37, 36 · diff · file · history

Wikipedia

Bladder cancer

Sources & links