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However, its utility has been limited as many patients are ineligible owing to their health status, and overall survival rates remain suboptimal. Recent advancements, including antibody-drug conjugates and immunotherapies, have begun to reshape the treatment landscape for LA\/mUC. The combination of enfortumab vedotin and pembrolizumab has shown promising clinical outcomes. The approval of multiple novel drugs and combination therapies not only provides new opportunities for patient care but also creates the need for physicians to adapt to this evolving therapeutic paradigm. This review explores the latest clinical data on the management of LA\/mUC and offers insights into sequencing therapies for patients with LA\/mUC.<\/jats:p>","DOI":"10.1200\/op-24-00758","type":"journal-article","created":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T16:00:17Z","timestamp":1743782417000},"page":"1765-1773","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":4,"title":["Lines of Therapy for Locally Advanced\/Metastatic Urothelial Carcinoma: The New Paradigm"],"prefix":"10.1200","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5666-6085","authenticated-orcid":false,"given":"Oluseyi","family":"Abidoye","sequence":"first","affiliation":[{"name":"Division of Hematology and Oncology, Mayo Clinic Arizona, Phoenix, AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prateek","family":"Jain","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology, Mayo Clinic Arizona, Phoenix, AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8548-6948","authenticated-orcid":false,"given":"Parminder","family":"Singh","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology, Mayo Clinic Arizona, Phoenix, AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"233","reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.3390\/medicina57080749"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2023.03.013"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/10732748231152322"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-023-00468-9"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21820"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1142"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-003-0382-8"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/oem.58.9.590"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-003-0377-5"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.99107705"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2018.09.001"},{"key":"e_1_3_6_13_2","doi-asserted-by":"crossref","first-page":"e0119313","DOI":"10.1371\/journal.pone.0119313","article-title":"Obesity and risk of bladder cancer: A dose-response meta-analysis of 15 cohort studies","volume":"10","author":"Sun JW","year":"2015","unstructured":"Sun JW, Zhao LG, Yang Y, et al: Obesity and risk of bladder cancer: A dose-response meta-analysis of 15 cohort studies. 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