PD-1/PD-L1 inhibitors remain the dominant class in the bladder cancer market in terms of patient share, and label expansions into earlier disease stages such as non-muscle invasive bladder cancer and muscle invasive bladder cancer will further grow the overall market. 

Although plagued by doubts surrounding PD-1/PD-L1 inhibitors’ performance in the first-line metastatic setting, data for the combination of Keytruda + Padcev and the combination of Opdivo + cisplatin-based chemotherapy showed strong survival benefits over standard-of-care chemotherapy, leading to approvals in the US. 

Balversa was the first FGFR inhibitor to be launched in bladder cancer and will dominate the FGFR-mutated patient segment after development of potential rivals Truseltiq and Pemazyre was suspended. However, an FGFR biomarker restriction, as well as the lack of routine FGFR alteration screening, will limit growth.