Platinum-based chemotherapy has long been the backbone of treatment for urothelial carcinoma. Immune checkpoint inhibitors have revolutionized the treatment paradigm and significantly improved outcomes for many patients. More recently, targeted agents such as erdafitinib and antibody drug conjugates enfortumab vedotin and sacituzumab govitecan have demonstrated robust efficacy after progression on prior chemotherapy and immunotherapy. Many additional agents are currently under investigation in ongoing clinical trials. In this review, we discuss the current treatment landscape, review recent clinical data resulting in approval of novel therapeutic agents and highlight important ongoing studies focusing on the therapeutic landscape beyond immune checkpoint inhibition.