title: Targeting the VEGF pathway in metastatic bladder cancer.
abstract: BACKGROUND
  Bladder cancer represents 7% of all new cancers diagnosed in the USA in 2015. Furthermore, the mortality of metastatic bladder cancer has not decreased substantially in the last four decades. Angiogenesis is known to play a major role in the pathogenesis of bladder cancer.
  
  
  METHODS
  The following article provides an overview of the first results of agents targeting the VEGF pathway in the treatment of metastatic bladder cancer.
  
  
  CONCLUSIONS
  Despite a few clinical trials providing preliminary encouraging results, the overall outcomes of the first published trials have been rather disappointing. In some instances, especially the case of trials which have investigated the use of new targeted agents as a single agent, no significant improvement in outcomes was seen, or was not sustained. In other cases, such as with combination trials, intolerable adverse effects have compromised the trials, due to overlapping toxicity between the targeted agent and chemotherapeutic agent(s). Further trials are warranted possibly combining different targeted agents or the use of sequential therapy. A better selection of the patient population may also be a key factor to improve patient outcomes, as many predictive factors of response seem to have already been identified.
authors.affiliation: Western University, Division of Urology and Division of Surgical Oncology , London, Ontario , Canada +1 519 685 8451 ; +1 519 685 8455 ; joseph.chin@lhsc.on.ca.
authors.forename: Clarisse R
authors.initials: CR
authors.lastname: Mazzola
authors.forename: Joseph
authors.initials: J
authors.lastname: Chin
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000818:Animals; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D006801:Humans; D009389:Neovascularization, Pathologic / Q000188:drug therapy; D040262:Receptors, Vascular Endothelial Growth Factor / Q000037:antagonists & inhibitors* / Q000276:immunology; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors* / Q000276:immunology
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D042461:Vascular Endothelial Growth Factor A; D040262:Receptors, Vascular Endothelial Growth Factor
keywords: RECIST; VEGF; angiogenesis; bevacizumab; bladder; bladder cancer; cabozantinib; metastases; metastasis; metastatic bladder cancer; metastatic urothelial carcinoma; pazopanib; ramucirumab; sorafenib; sunitinib; targeted agents; targeted therapies; urothelial; urothelial carcinoma