[Current and future treatment stratification of metastatic urothelial carcinoma: a great opportunity for true precision oncology].

For many decades, the treatment of metastatic urothelial carcinoma (mUC) has been dominated by platinum-containing chemotherapies. The latest version is the introduction of immune checkpoint inhibitors, especially in combination with modern antibody-drug conjugates (ADC) and FGFR3 inhibitors, but this therapeutic standard has been overtaken in some indications. Nevertheless, biomarker-guided therapy decisions have rarely been used to date. However, the biomarkers available to date have only helped in isolated therapeutic situations. For ADCs, however, this could change substantially when there is high expression variability of various targets such as NECTIN-4, Her2neu, EGFR and TROP2. The presence of activating FGFR3 mutations or fusions also opens up a clearly defined, albeit small, therapeutic niche that could possibly become larger in the future for localised stages of urothelial carcinoma. Biomarker stratification of tumours will presumably become indispensable in the future if we are to control and use these therapeutic innovations in a targeted and precise manner. Current developments therefore possess great potential for genuine precision oncology.