BERKELEY, CA (UroToday.com) - Urothelial carcinoma (UC), despite the myriad of treatment approaches and our progressively increasing knowledge into its disease processes, remains one of the most clinically challenging problems in modern health care. New therapies target biomolecular products and cellular receptors responsible for regulating cell growth and metabolism, both of which are frequently overexpressed in malignant urothelial cells, with the intent of inducing cell death by limiting cellular metabolism and growth, creating an immune response, or selectively delivering or activating a cytotoxic agent. These new and novel therapies may offer a potential for reduced toxicity and further hope for better outcomes, particularly for disease refractory or not amendable to the current standards of treatment.
Platinum-based neoadjuvant and adjuvant systemic chemotherapies are options for muscle-invasive UC exhibiting adverse clinic-pathologic features and locally advanced UC, with an improved OS. Unfortunately, surgery has no curative role in metastatic UC, where platinum-based systemic chemotherapy has been the mainstay of treatment for these patients. The classic regimen of methotrexate, vinblastine, doxorubicin (adriamycin), and cisplatin (MVAC) has mostly been replaced by gemcitabine and cisplatin (GC) as a first-line regimen given the similar efficacy and more favorable toxicity profile of GC. As we continually improve our understanding of the pathobiology of UC, new agents are being developed and investigated, including cytotoxic chemotherapy, targeted therapy (vascular endothelial growth factor (VEGF), epidermal growth factor receptor (EGFR)), and immunotherapy. The present review will delineate the encouraging role such targeted therapies may have in the treatment of locally advanced/metastatic UC in the years to come.
Philippe E. Spiess, MD, MSc, FACS, FRCS(C) as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL USA 33612