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Targeted therapy for advanced urothelial cancer of the bladder: where do we stand?
Zhaowei Zhu1, Zhoujun Shen, Chen Xu
1Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Abstract:
The treatment of advanced urothelial cancer of the bladder has evolved substantially during recent years. Chemotherapy has been the mainstay of treatment and confers survival advantage. Despite such advances, the chemotherapy of bladder cancer is far from satisfactory due to severe side effects. Targeted therapy with novel drugs directed at specific molecular pathways opens promising new avenues to improve patient outcome. A systematic review examined the clinical data for novel targeted agents in 10 phase II trials, with a focus on bevacizumab, aflibercept, sunitinib, sorafenib, gefitinib, lapatinib and trastuzumab. Besides, we present studies on other novel, promising targeted agents, including pazopanib, cetuximab and everolimus. Although bevacizumab and trastuzumab have shown promising results for patients with advanced bladder cancer, other targeted agents have not achieved the same clinical benefit in this disease as seen in other common epithelial cancers. Ultimately, combination targeted therapy, sequential therapy, adjuvant and neoadjuvant therapy may yield the best outcomes.
Insights
Novel targeted therapies show promise for advanced urothelial bladder cancer, but results vary. Bevacizumab and trastuzumab offer benefits, while other agents need further investigation for improved patient outcomes.
Area of Science:
- Oncology
- Pharmacology
Background:
- Chemotherapy remains standard for advanced urothelial bladder cancer, offering survival benefits but causing significant side effects.
- Targeted therapies represent a promising new direction for improving patient outcomes by targeting specific molecular pathways.
Purpose of the Study:
- To systematically review clinical data on novel targeted agents for advanced urothelial bladder cancer.
- To evaluate the efficacy of agents like bevacizumab, aflibercept, sunitinib, sorafenib, gefitinib, lapatinib, trastuzumab, pazopanib, cetuximab, and everolimus.
Main Methods:
- Systematic review of 10 phase II clinical trials.
- Analysis of clinical data for various targeted agents in urothelial bladder cancer treatment.
Main Results:
- Bevacizumab and trastuzumab demonstrated promising results in advanced urothelial bladder cancer.
- Other targeted agents did not achieve the same clinical benefit as observed in other epithelial cancers.
- The efficacy of targeted agents varies significantly in this patient population.
Conclusions:
- Targeted therapy offers a promising avenue for advanced urothelial bladder cancer, though efficacy differs among agents.
- Combination, sequential, adjuvant, and neoadjuvant targeted therapy approaches may offer the best outcomes.
- Further research is needed to optimize targeted therapy strategies for urothelial bladder cancer.
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