| Disease stage | Treatment type | Specific agents / procedures | Mechanism of action | Indication / use case | Response rate / key efficacy data | FDA status / regulatory note | Suggested MAXO term(s) | Evidence |
|---|---|---|---|---|---|---|---|---|
| NMIBC | Endoscopic surgery | Transurethral resection of bladder tumor (TURBT) | Endoscopic resection/debulking for diagnosis, staging, and local control | Initial management of most NMIBC; foundation before adjuvant intravesical therapy | Standard first intervention; recurrence remains common, with NMIBC recurrence reported at ~31–78% within 5 years in review literature | Standard of care | MAXO: transurethral resection; endoscopic surgical excision | (pqac-00000012, pqac-00000011) |
| NMIBC | Intravesical immunotherapy | Bacillus Calmette-Guérin (BCG) | Local immune activation in bladder, promoting antitumor immunity | Gold standard for high-grade/high-risk NMIBC after TURBT; reduces recurrence and progression | Widely accepted standard; exact pooled response not given in available contexts, but described as gold standard for high-risk NMIBC | FDA-approved, established standard | MAXO: intravesical immunotherapy; bacillus Calmette-Guérin administration | (pqac-00000012, pqac-00000001) |
| NMIBC | Intravesical chemotherapy | Post-TURBT intravesical chemotherapy (agent not always specified in source context) | Local cytotoxic exposure to residual urothelial tumor cells | Low/intermediate-risk NMIBC after TURBT; also used when recurrence-risk reduction is desired | Standard adjunctive therapy; exact response rates not stated in available contexts | Standard practice; specific agents vary | MAXO: intravesical chemotherapy administration | (pqac-00000001, pqac-00000012) |
| BCG-unresponsive NMIBC | Systemic immunotherapy | Pembrolizumab | PD-1 checkpoint blockade restoring antitumor T-cell activity | High-risk BCG-unresponsive NMIBC in patients seeking bladder preservation / not undergoing cystectomy | Described as a recent FDA-approved option; exact CR rate not stated in available contexts here | FDA-approved for BCG-unresponsive high-risk NMIBC | MAXO: immune checkpoint inhibitor therapy; pembrolizumab administration | (pqac-00000012) |
| BCG-unresponsive NMIBC | Intravesical gene therapy | Nadofaragene firadenovec (Adstiladrin) | Gene therapy delivering interferon pathway stimulation via adenoviral vector | Conservative treatment option for BCG-unresponsive NMIBC | Reported as promising and FDA-approved in review literature; exact response metrics not stated in available contexts | FDA-approved | MAXO: intravesical gene therapy; viral vector gene delivery | (pqac-00000012) |
| High-risk / refractory NMIBC | Radical surgery | Radical cystectomy | Complete removal of bladder for definitive local control | Recommended for selected high-risk, recurrent, or BCG-unresponsive NMIBC | Offers definitive local control but with major morbidity; no single response rate stated | Standard of care option | MAXO: cystectomy; radical surgical excision | (pqac-00000012) |
| MIBC | Radical surgery | Radical cystectomy with lymph node dissection | Removal of primary tumor and regional nodes | Standard local treatment for localized MIBC | Standard of care; overall outcomes depend on pathologic stage and perioperative therapy | Standard of care | MAXO: cystectomy; lymph node dissection | (pqac-00000001, pqac-00000003, pqac-00000012) |
| MIBC | Neoadjuvant systemic chemotherapy | Cisplatin-based chemotherapy (commonly gemcitabine/cisplatin in modern practice) | Platinum-induced DNA damage/crosslinking causing tumor cell death | Standard pre-cystectomy treatment for cisplatin-eligible MIBC | Standard of care; review notes improved outcomes and pathologic response in neoadjuvant setting, but exact pooled rate not given in available contexts | Standard of care | MAXO: neoadjuvant chemotherapy; platinum-based chemotherapy | (pqac-00000001, pqac-00000012) |
| MIBC (cisplatin-ineligible or selected bladder preservation) | Bladder-preserving multimodality therapy | TURBT + chemoradiation / trimodality therapy | Maximal resection plus radiosensitizing systemic therapy and radiation | Alternative to cystectomy for selected localized MIBC | Recognized standard bladder-preservation approach in suitable patients; exact response rate not listed in available contexts | Guideline-supported standard in selected patients | MAXO: combined modality therapy; radiochemotherapy; bladder preservation therapy | (pqac-00000001, pqac-00000012) |
| MIBC (adjuvant) | Immunotherapy | Nivolumab | PD-1 checkpoint blockade | High-risk muscle-invasive urothelial carcinoma after radical surgery | CheckMate-274 described as showing disease-free survival benefit | FDA-approved adjuvant therapy | MAXO: adjuvant immunotherapy; nivolumab administration | (pqac-00000002, pqac-00000012) |
| MIBC (neoadjuvant, investigational/expanding) | Chemo-immunotherapy | Gemcitabine + cisplatin + pembrolizumab | Cytotoxic chemotherapy plus PD-1 blockade | Investigational / phase 2 neoadjuvant approach for MIBC | In LCCC1520, 22/39 patients responded by pathologic downstaging | Investigational / not established standard from available contexts | MAXO: neoadjuvant chemoimmunotherapy; pembrolizumab administration | (pqac-00000012) |
| Advanced / metastatic UC | First-line systemic chemotherapy | Cisplatin-based regimens | Platinum DNA crosslinking with combination cytotoxic therapy | Standard first-line treatment for cisplatin-eligible locally advanced/metastatic UC | Remains standard first-line option; exact ORR not given in available contexts | Established standard | MAXO: systemic chemotherapy; platinum-based chemotherapy | (pqac-00000006, pqac-00000012) |
| Advanced / metastatic UC | First-line systemic chemotherapy | Carboplatin-based regimens | Platinum-based cytotoxic therapy for cisplatin-ineligible patients | Front-line option for cisplatin-ineligible advanced UC | In a US cohort, carboplatin-containing regimens were the most common first-line therapy (30.9%) | Standard clinical option | MAXO: systemic chemotherapy; carboplatin administration | (pqac-00000006) |
| Advanced / metastatic UC | Immunotherapy | Pembrolizumab, nivolumab, avelumab; PD-1/PD-L1 inhibitors as a class | Immune checkpoint blockade | Used after platinum progression; some agents used in cisplatin-ineligible disease or maintenance settings depending on label | In the US cohort, PD-1/PD-L1 inhibitors were 29.9% of first-line treatments and predominant in later lines (52.0% second line) | Multiple FDA approvals in UC settings | MAXO: immune checkpoint inhibitor therapy; PD-1 inhibitor therapy; PD-L1 inhibitor therapy | (pqac-00000006, pqac-00000012) |
| Advanced / metastatic UC | Targeted therapy | Erdafitinib | Pan-FGFR tyrosine kinase inhibitor targeting susceptible FGFR2/3 alterations | FGFR2/3-altered metastatic UC after prior therapy | Real-world response rate reported as 40%; median PFS 2.8 months; median OS 6.6 months | FDA-approved targeted therapy | MAXO: targeted molecular therapy; fibroblast growth factor receptor inhibitor therapy; erdafitinib administration | (pqac-00000011) |
| Advanced / metastatic UC | Antibody-drug conjugate | Enfortumab vedotin | Anti-Nectin-4 antibody linked to monomethyl auristatin E, delivering microtubule toxin to tumor cells | Advanced/metastatic UC after prior therapy; increasingly used in later lines | In US practice, adoption increased after 2019; 8.1% of second-line and 18.6% of third-line treatments in one cohort | FDA-approved | MAXO: antibody-drug conjugate therapy; enfortumab vedotin administration | (pqac-00000006, pqac-00000011) |
| Advanced / metastatic UC | Antibody-drug conjugate | Sacituzumab govitecan | Anti-Trop-2 antibody linked to SN-38 (topoisomerase I inhibitor payload) | Later-line advanced/metastatic UC | In US practice, used in 0.5% of second-line and 4.0% of third-line treatments in one cohort, reflecting newer adoption | FDA-approved during study period context | MAXO: antibody-drug conjugate therapy; sacituzumab govitecan administration | (pqac-00000006, pqac-00000011) |
| Advanced / metastatic UC | Immunotherapy +/or targeted sequencing-guided care | Biomarker-directed treatment selection (FGFR, PD-L1, ctDNA, DDR alterations) | Precision-oncology stratification | Increasingly relevant across metastatic disease to select patients for checkpoint blockade or FGFR inhibition | Reviews emphasize urgent need for better selection criteria rather than uniform benefit for all patients | Biomarker use partly established, partly evolving | MAXO: precision medicine treatment selection; molecularly guided therapy | (pqac-00000012, pqac-00000011) |
| UTUC / invasive urothelial carcinoma | Perioperative chemotherapy | Platinum-based neoadjuvant or adjuvant chemotherapy | DNA-damaging cytotoxic therapy | High-grade upper tract urothelial carcinoma and invasive urothelial carcinoma | POUT trial summarized as DFS 70% vs 51% at 2 years for adjuvant platinum chemotherapy vs surveillance; retrospective pathologic response in UTUC neoadjuvant cohorts ~48% | Guideline-supported in selected patients | MAXO: adjuvant chemotherapy; neoadjuvant chemotherapy; nephroureterectomy-associated systemic therapy | (pqac-00000002) |


*Table: This table summarizes stage-specific treatment modalities for transitional cell carcinoma/urothelial carcinoma, from NMIBC to metastatic disease. It links therapies to mechanisms, indications, efficacy signals, regulatory status, and suggested MAXO-style annotations for knowledge-base use.*