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Currently, systemic platinum\u2010based chemotherapy followed by avelumab maintenance therapy is the only first\u2010line treatment for mUC that has an overall survival benefit. Cisplatin\u2010based chemotherapy (usually in combination with gemcitabine) is the preferred treatment but carboplatin is substituted where contraindications to cisplatin exist. Treatment with immune checkpoint inhibitors, antibody\u2010drug conjugates, and kinase inhibitors has not yet demonstrated superiority to chemotherapy as first\u2010line therapy and remains investigational in this setting. A recent media release indicates that chemotherapy plus nivolumab gives an OS advantage as first\u2010line treatment but results of this study have not yet been made public. Pembrolizumab remains an option in those having primary progression on first\u2010line chemotherapy or within 12 months of neoadjuvant chemotherapy. The antibody\u2010drug conjugate, enfortumab vedotin has TGA approval for patients whose cancer has progressed following chemotherapy and immunotherapy and has just received a positive Pharmaceutical Benefits Scheme recommendation. The use of molecular screens for somatic genetic mutations, gene amplifications, and protein expression is expanding as drugs that target such abnormalities show promise. However, despite these advances, a substantial proportion of patients with mUC have significant barriers to receiving any treatment, including advancing age, frailty, and comorbidities, and less toxic, effective therapies are needed.<\/jats:p>","DOI":"10.1111\/ajco.14001","type":"journal-article","created":{"date-parts":[[2023,9,20]],"date-time":"2023-09-20T07:32:34Z","timestamp":1695195154000},"page":"585-595","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Systemic treatment of advanced and metastatic urothelial cancer: The landscape in Australia"],"prefix":"10.1111","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0217-5261","authenticated-orcid":false,"given":"Howard","family":"Gurney","sequence":"first","affiliation":[{"name":"Faculty of Medicine Health and Health Sciences Macquarie University  Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy D.","family":"Clay","sequence":"additional","affiliation":[{"name":"St John of God Subiaco Hospital Subiaco  Washington Australia"},{"name":"Icon Cancer Care, Midland  Washington Australia"},{"name":"School of Medical and Health Sciences Edith Cowan University, Joondalup  Washington Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niara","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Mater Hospital Brisbane Mater Misericordiae Ltd.  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