title: Emerging drugs for urothelial carcinoma.
abstract: BACKGROUND
  Advanced urothelial carcinoma is associated with a poor prognosis. In the metastatic setting, the response rate to first-line, cisplatin-containing chemotherapy is high, but survival is poor. Second-line treatment options are limited. Advanced age at diagnosis and the presence of comorbidities often preclude treatment with cisplatin-containing regimens.
  
  
  METHODS
  This review addresses the current therapy of urothelial carcinoma, the unmet needs in treatment and the status of drug development in this disease. The molecular targets identified and efforts to incorporate targeted agents into therapy will be addressed.
  
  
  CONCLUSIONS
  There have been no major advances in the treatment of urothelial carcinoma in three decades. Despite high response rates in the first-line setting, survival is limited. Major impediments to improved outcomes include poor durability of response to first-line chemotherapy and lack of second-line treatments. Better understanding in tumor biology has identified multiple targets in urothelial carcinoma; however, such discoveries have yet to lead to the incorporation of targeted agents into the routine treatment of urothelial carcinoma. Multiple ongoing clinical trials are investigating the use of targeted agents in urothelial carcinoma. Continued efforts are underway to better understand the molecular drivers of disease and such efforts are likely to identify additional therapeutic targets.
authors.affiliation: Albert Einstein College of Medicine, Montefiore Medical Center, Department of Medical Oncology , 111 E 210th St, Bronx, NY, 10467 , USA +1 718 920 4826 ; +1 718 798 7474 ; bgartrel@montefiore.org.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Gartrell
authors.forename: Guru
authors.initials: G
authors.lastname: Sonpavde
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002277:Carcinoma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D018572:Disease-Free Survival; D055808:Drug Discovery; D006801:Humans; D058990:Molecular Targeted Therapy; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D019459:Urothelium / Q000187:drug effects* / Q000473:pathology / Q000528:radiation effects / Q000601:surgery
chemical_list: D016190:Carboplatin; D002945:Cisplatin