Metastatic bladder cancer has historically been treated with platinum-based chemotherapy as the standard firstline therapy. Since the introduction of cisplatin-based regimens, advancements in treatment strategies have been limited. However, the recent emergence of immune checkpoint inhibitors (ICIs) and antibody-drug conjugates (ADCs) has significantly transformed the treatment landscape. Notably, the combination of enfortumab vedotin (EV) and pembrolizumab has demonstrated considerable clinical benefits, challenging traditional chemotherapy. This review aims to provide an overview of recent advancements in the treatment of metastatic bladder cancer.Current Concepts: Recent phase III clinical trials, notably EV-302/KEYNOTE-A39 and CheckMate 901, have reshaped the first-line management. EV combined with pembrolizumab has shown superior progression-free survival and overall survival compared to platinum-based chemotherapy, establishing it as a new standard of care. Patients ineligible for this regimen due to underlying comorbidities or toxicity may still benefit from alternative options. Such alternatives include platinum-based chemotherapy with ICI maintenance therapy, including avelumab or nivolumab. The selection of treatments should be individualized, taking into account specific patient factors, particularly platinum eligibility, renal function, and performance status.Discussion and Conclusion: The incorporation of ICIs and ADCs into the therapeutic landscape for metastatic bladder cancer has significantly improved patient outcomes. EV plus pembrolizumab has demonstrated substantial survival benefits, establishing it as a preferred first-line regimen for eligible patients. However, not all patients are candidates for this combination, emphasizing the necessity of individualized treatment strategies. Future research should focus on managing treatment-related adverse events and developing personalized therapies to maximizing efficacy while minimizing toxicity.

Background: Patients with diabetes are known to be at high risk for end-stage kidney disease (ESKD), but the accurate annual risk data for new-onset ESKD is still limited. In South Korea, the prevalence and incidence of ESKD are increasing more rapidly compared to the global average. This study aimed to determine the incidence rate (IR) of ESKD by diabetes status from 2012 to 2022. Methods: Using data from the Korean National Health Insurance Service, we calculated the IR and hazard ratio (HR) for newonset ESKD in the general population. Individuals were categorized based on diabetes status into nondiabetes, impaired fasting glucose (IFG), diabetes duration <5 and ≥5 years. Results: Among the participants, 67.6% were nondiabetic, 22.3% had IFG, and 10% had diabetes. In Korea, the IRs of ESKD were 139 per million population (pmp) for nondiabetes, 188 pmp for IFG, 632 pmp for diabetes <5 years, and 3,403 pmp for diabetes ≥5 years. An advanced estimated glomerular filtration rate (eGFR) category was the strongest risk factor for ESKD development. However, even in patients with normal renal function, those with long-standing diabetes had a 14-fold higher risk of ESKD compared to nondiabetic individuals. The risk of ESKD associated with diabetes increased exponentially with declining renal function. Notably, IFG showed an increasing tendency for ESKD in younger patients (<65 years) with early-stage chronic kidney disease (CKD; eGFR ≥60 mL/min/1.73 m²). Conclusion Longer diabetes duration amplifies ESKD risk, particularly as renal function declines. Even in patients with normal renal function, long-standing diabetes significantly increases ESKD risk, while IFG is associated with elevated risk only in younger individuals with early-stage CKD.

Background/Aims: Elevated gamma-glutamyl transferase (GGT) levels indicate hepatic dysfunction and have been linked to an increased risk of pancreatobiliary cancers. However, this association, particularly in individuals with diabetes mellitus (DM), requires elucidation. We aimed to examine the association between elevated serum GGT levels and pancreatobiliary cancer risk in patients with diabetes. Methods: Our study included data from the National Health Insurance Service (NHIS) database for 2,459,966 adults aged >20 years diagnosed with DM between 2009 and 2012. We examined the association between serum GGT levels and pancreatobiliary cancer risk, considering DMrelated factors. Serum GGT levels were categorized into quartiles, and Cox proportional hazards analysis was performed to evaluate the association between serum GGT levels and pancreatobiliary cancer risk. Results: Over a median follow-up period of 7.2 years, 21,795 patients (0.89%) were newly diagnosed with pancreatobiliary cancer. The adjusted hazard ratio for pancreatobiliary cancer in quartiles 2–4 compared with that in quartile 1 was 1.091, 1.223, and 1.554, respectively, demonstrating a significant upward trend (p<0.001). This association remained consistent across all cancer types and was independent of the DM duration or treatment regimen. Conclusions Elevated serum GGT levels were independently associated with an increased risk of pancreatobiliary cancer, regardless of the duration of DM or the use of oral hypoglycemic agents and insulin. While these findings suggest the potential utility of serum GGT as a biomarker for identifying individuals at higher risk of pancreatobiliary cancer within the diabetic population, further research is needed to validate its clinical applicability.

Metastatic bladder cancer has historically been treated with platinum-based chemotherapy as the standard firstline therapy. Since the introduction of cisplatin-based regimens, advancements in treatment strategies have been limited. However, the recent emergence of immune checkpoint inhibitors (ICIs) and antibody-drug conjugates (ADCs) has significantly transformed the treatment landscape. Notably, the combination of enfortumab vedotin (EV) and pembrolizumab has demonstrated considerable clinical benefits, challenging traditional chemotherapy. This review aims to provide an overview of recent advancements in the treatment of metastatic bladder cancer.Current Concepts: Recent phase III clinical trials, notably EV-302/KEYNOTE-A39 and CheckMate 901, have reshaped the first-line management. EV combined with pembrolizumab has shown superior progression-free survival and overall survival compared to platinum-based chemotherapy, establishing it as a new standard of care. Patients ineligible for this regimen due to underlying comorbidities or toxicity may still benefit from alternative options. Such alternatives include platinum-based chemotherapy with ICI maintenance therapy, including avelumab or nivolumab. The selection of treatments should be individualized, taking into account specific patient factors, particularly platinum eligibility, renal function, and performance status.Discussion and Conclusion: The incorporation of ICIs and ADCs into the therapeutic landscape for metastatic bladder cancer has significantly improved patient outcomes. EV plus pembrolizumab has demonstrated substantial survival benefits, establishing it as a preferred first-line regimen for eligible patients. However, not all patients are candidates for this combination, emphasizing the necessity of individualized treatment strategies. Future research should focus on managing treatment-related adverse events and developing personalized therapies to maximizing efficacy while minimizing toxicity.