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VEGF inhibition in urothelial cancer: the past, present and future

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Abstract

Purpose

To describe the role of anti-angiogenic agents that have been used as a treatment approach for locally advanced or metastatic urothelial cancers and to propose future directions.

Methods

PubMed/MEDLINE was searched for articles related to VEGF inhibition and locally advanced or metastatic urothelial cancer.

Results

Angiogenesis is a fundamental process for urothelial cancer initiation and progression. First-line therapy for locally advanced or metastatic urothelial cancer includes cisplatin-based chemotherapy combinations; subsequent systemic therapy includes taxanes, nanoparticle albumin-bound (nab) paclitaxel, or pemetrexed. More recently, several anti-PD-L1 and anti-PD-1 antibodies have shown promising activity in the first-line and post-platinum setting; however, immunotherapy remains ineffective in most patients. FGFR inhibitor erdafitinib was recently approved in the third-line setting. Studies on bevacizumab, pazopanib and ramucirumab have shown improved response rates when added to chemotherapy in selected patients, but have not led to overall survival (OS) benefit in randomized controlled studies.

Conclusion

Anti-angiogenic agents have shown promise in recent studies treating locally advanced or metastatic urothelial cancer. However, further work is needed to elucidate ideal treatment combinations in selected patient populations to maximize benefit, with the ultimate goal of being added to the FDA-approved treatment armamentarium for this disease.

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Correspondence to Alexandra Drakaki.

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Conflict of interest

Dr. Drakaki does consulting for Astra Zeneca, served in advisory board for Seattle Genetics/Astellas and Janssen, receives research funding from KITE/Gilead, and receives travel support from Eli Lilly and Astra Zeneca. Her institution receives research support from BMS, MERCK, GENENTECH, ASTRA ZENECA, KITE/GILEAD, ELI LILLY.

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Ghafouri, S., Burkenroad, A., Pantuck, M. et al. VEGF inhibition in urothelial cancer: the past, present and future. World J Urol 39, 741–749 (2021). https://doi.org/10.1007/s00345-020-03213-z

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  • DOI: https://doi.org/10.1007/s00345-020-03213-z

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