Prof. Bian Xiaojie on the ADC Treatment Landscape in Urologic Tumors

At the 2026 Pujiang Urologic Oncology Conference in Shanghai

On August 21 and 22, 2026, the Pujiang Urologic Oncology Academic Conference was held in Shanghai. Under the theme of precision integration and innovation for the future, the meeting brought together experts from across China's urologic oncology field for in-depth exchange on precision diagnosis and treatment, multidisciplinary integration, the translation of innovation into practice, and new models of urologic cancer care.

During the conference, Prof. Bian Xiaojie — an invited expert at Fudan University Shanghai Cancer Center and at China Pharmaceutical University's Shanghai GOBROAD Cancer Hospital — gave an interview to China Medical Tribune, sharing her comprehensive thinking on the forward movement of antibody-drug conjugates in urologic oncology, on sequencing strategy, and on cross-tumor-type development.

Drawing on practice in urothelial carcinoma and other genitourinary tumors, she set out the decision nodes that govern how these drugs advance, the principles that should shape sequencing after a microtubule-inhibitor payload, and the targets and tumor types now opening up to ADC development.

1. What Are the Key Decision Nodes as ADCs Advance From Later Lines to Earlier Lines?

In the treatment of urothelial carcinoma, what are the key decision nodes in moving ADC drugs from later lines to earlier lines?

Many clinical trials are, in essence, designed starting from real clinical problems and patient needs. In urothelial carcinoma, most patients are first diagnosed at the non-muscle-invasive bladder cancer (NMIBC) stage, while advanced patients account for only about 5% — yet this group has a poorer overall prognosis and shorter survival. For that reason, earlier studies mostly began with late-line treatment of advanced disease, exploring how to prolong overall survival and improve quality of life.

ADC drugs have followed a similar path: beginning with late-line monotherapy, then moving gradually forward to second-line and even first-line treatment of advanced disease; and once first-line treatment produces clear tumor-response data, moving further forward into the perioperative setting, to see whether it can reduce the risk of recurrence after radical surgery or raise the probability of preserving the bladder. The choice of treatment regimen and the direction of clinical research are, in other words, always grounded in the patient's condition and in clinical need.

2. Target Rotation or Same-Target Deepening: What Should ADC Sequencing Follow?

As ADC drugs become more plentiful, what principles should a reasonable ADC sequencing strategy follow — should it rotate targets, or deepen along the same target?

The ADCs most widely used in urothelial carcinoma today fall into two main classes: those targeting Nectin-4, such as enfortumab vedotin (EV), and those targeting HER2, such as disitamab vedotin (DV). The two share one important feature: their payload is a microtubule inhibitor (MMAE). How to sequence treatment after an MMAE-class drug is therefore a thorny clinical question — whether to continue MMAE sequencing between EV and DV, or to switch to an ADC carrying a topoisomerase inhibitor payload.

Preliminary clinical results have already appeared at recent international meetings. At the 2026 ASCO Annual Meeting, for example, it was reported that after EV treatment, sequencing a Nectin-4 ADC with a topoisomerase inhibitor payload still produced an objective response rate of about 31%. By contrast, sequencing MMAE after MMAE — as in the RC48-G001 study, in which DV and EV were used in crossover — gave an overall objective response rate that was not encouraging. The implication is that when the target is the same or similar, sequencing by changing the payload is likely to benefit patients more.

For treatment-naive patients, the choice of ADC also needs to be subdivided further according to target expression. Nectin-4 is expressed at a high rate in urothelial carcinoma, generally above 80%; in the EV-302 study, patients who did not express Nectin-4 accounted for only about 1%. By comparison, patients with high HER2 expression may benefit more clearly from DV — whether the score is IHC 1+, IHC 2+, or IHC 3+, the overall objective response rate can exceed 80%. Stratifying patients in this way, by molecular feature, allows more precise treatment choices.

3. Beyond a Single Tumor Type: The ADC Development Landscape Across Genitourinary Tumors

The use and exploration of ADCs in urologic tumors is not confined to one tumor type. From a cross-tumor-type perspective, what are the similarities and differences in ADC development strategy and prospects for genitourinary tumors?

Among genitourinary tumors, the widest use of ADCs today is in urothelial carcinoma; prostate cancer is also being explored, while renal cell carcinoma has somewhat stalled over the past two years. Renal cancer saw earlier research into CD70-targeted ADCs, but progress was blocked for a number of reasons, and the only agent still under way today may be one carrying an MMAE payload. In prostate cancer, B7-H3-targeted ADCs have been explored more extensively, with three to four large clinical studies already advancing; beyond that, ADCs against new targets such as the EGFR family, ROR1, PSMA, and STEAP1 are entering the pipeline.

In urothelial carcinoma, existing drugs have shown clear efficacy in later-line treatment and have produced preliminary results in the perioperative setting. At the same time, systemic therapy and local instillation therapy are moving from bladder cancer up to upper tract urothelial carcinoma (UTUC) and even to high-risk NMIBC, with some phase II preliminary results already in hand. These approaches are not yet approved, but phase III protocols will be designed around clinical need, with the aim of offering patients better options.

Fudan University Shanghai Cancer Center has also begun exploring ADCs in NMIBC: in high-risk patients with high HER2 expression, the center is comparing ADC combined with BCG against BCG alone. That study is currently in the enrollment stage, and it is hoped that positive results will follow and bring further benefit to patients.

Content source: China Medical Tribune. Originally published by Shanghai GOBROAD Cancer Hospital on September 11, 2026.

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