Antibody-drug conjugates in metastatic urothelial cancer: Highway to heaven

Metastatic urothelial carcinoma (mUC) is a challenging malignancy with historically limited treatment options. Advances in understanding its biology have enabled the development of innovative therapies, including immune checkpoint inhibitors and antibody-drug conjugates (ADCs). ADCs, such as enfortumab vedotin, sacituzumab govitecan, and trastuzumab deruxtecan, represent transformative advancements, offering targeted delivery of cytotoxic agents. This review highlights the evolving role of ADCs in mUC, examining their mechanisms, clinical efficacy, patient selection criteria, genetic insights, and future directions in personalized treatment strategies.