Balancing Quality of Life and Survival in Maintenance Therapy: Current Practice and Future Directions

This segment explores how clinicians balance quality of life and survival when using maintenance therapy in advanced urothelial (bladder) carcinoma, while also looking ahead to future treatment directions. The speaker explains that many patients are older and prioritize maintaining independence, daily functioning, and minimal treatment burden, even as therapy aims to prolong survival. Maintenance immunotherapy is highlighted as a way to control disease with generally manageable toxicity, especially compared with extended chemotherapy courses.

The discussion then shifts to the evolving treatment landscape: emerging molecular targets, antibody–drug conjugates (including dual-targeted approaches), next-generation targeted agents, and strategies to intensify or de-escalate regimens to better preserve quality of life (for example, adjusting combinations like antibody–drug conjugates plus immunotherapy). Finally, the segment outlines the growing role of circulating tumor DNA (ctDNA) in the adjuvant and post-adjuvant settings as a prognostic tool and, potentially, a future guide for tailoring treatment intensity and timing for individual patients.