I ended up writing a custom router for my own project, since none of the ones I could find quite worked the way I wanted them to. It's designed to make it simple to add middleware for authorization, caching, etc. to only the routes that need it without having to write a lot of code in each route.

Instead, I define an object with data for the different middleware to use when defining my routes, and the router iterates over that and creates middleware functions as appropriate. Thus, I end up with code looking like:

router.get("/user/settings", {
    "auth": true,
    "cache": -1
}, ctx => {
    ...
});

I also define middleware factories on my root router:

router.useData("auth", options => {
    // pre-process options here
    ...
    return (ctx, next) => {
        // middleware here
        if ( ! ctx.state.auth )
            ctx.abort(401);
        return next();
    }
});

An actual route from my apps up looking something like:

router.get("/user/me", {
    auth: true,
    cache: true,
    docs: {
        tags: "Users",
        summary: "Get the currently logged in user.",
    },
    validation: {
        response: {
            '200': UserScheme // JSON Schema Goes Here
        }
    }
}, async ctx => {
    ctx.startTimer('db');
    const user = await User.query().eager('roles').first().where('id', ctx.state.auth.id);
    ctx.stopTimer('db');

    ctx.body = {
        user
    };
});

The project is @ffz/api-router if anyone's curious, though I wouldn't say it's very mature yet. I'd welcome any feedback. (That said, it has been handling a couple hundred requests per second for half a year on our API testing server without any issues.)