Urothelial carcinoma is a common malignancy that affects the urinary system, with bladder cancer being the most prevalent form. Although the management of early-stage disease has seen significant improvements, the treatment of locally advanced and metastatic urothelial carcinoma remains challenging. Over the past decade, there has been an explosion in the number of therapies available for the treatment of advanced disease, with immune checkpoint inhibitors and antibody-drug conjugates leading the way. Enfortumab vedotin is an antibody-drug conjugate that targets Nectin-4, a protein that is overexpressed in urothelial carcinoma cells. In clinical trials, it has shown promising outcomes for the treatment of advanced urothelial carcinoma that has progressed after chemotherapy or immunotherapy. The US Food and Drug Administration has granted expedited approval for enfortumab vedotin in the treatment of advanced urothelial carcinoma. This review provides an overview of the current and emerging treatments for urothelial carcinoma, with a particular focus on enfortumab vedotin. We discuss the mechanisms of action, clinical efficacy, safety, and ongoing research of enfortumab vedotin, along with the current landscape of other approved therapies and promising agents in development. The aim of this review is to provide a comprehensive and upto-date summary of the available treatment options for urothelial carcinoma, including their limitations and future prospects.
Antibiotic resistance has become a critical public health issue due to the overuse and misuse of antibiotics. Despite ongoing efforts to develop stronger antibiotics, bacterial resistance continues to evolve, leading to a global crisis. Effective antibiotics are becoming scarce, and diseases that were once treatable are now becoming uncontrollable. There is a need for new solutions to preserve the current antibiotic arsenal and combat bacterial resistance. Narrow-spectrum antibiotics which do not contribute to multidrug resistance could be a solution instead of broad-spectrum antibiotics.
One potential solution is phage therapy, which uses bacteriophages to target specific bacteria without harming healthy cells. Plants are another potential solution because they contain natural antibacterial compounds like polyphenols and alkaloids. Antimicrobial proteins (AMPs) from eukaryotes can also be a good substitute for antibiotics because they do not require a receptor and minimize the chance of bacterial resistance. A clinical trial on women with recurrent UTI was performed. The results of which revealed that overall methenamine hippurate is effective in reducing the intake of antibiotics. Whole genome sequencing is a rapidly evolving method through which resistance pathways are identified to tackle resistance. Developing metallophores is an area of great potential and metal complexes are more likely to advance towards becoming a clinically approved replacement to antibiotics. The development of new solutions is critical to prevent the spread of antibiotic-resistant bacteria and ensure that bacterial infections remain treatable.
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