Ramucirumab and docetaxel in patients with metastatic urothelial carcinoma harboring fibroblast growth factor receptor alterations: A case series and literature review

• Type of Material: Article
• Authors: Mehmet Bilen, Emory University; Katherine Emilie Rhoades Smith, Emory University; Emilie Hitron, Emory University; Greta A Russler, Emory University; Deborah Baumgarten, Emory University
• Language: English
• Date: 2020-01-01
• Publisher: Wolters Kluwer - Medknow
• Publication Version: Final Published Version
• Copyright Statement: Published by Wolters Kluwer - Medknow; © 2020 Journal of Immunotherapy and Precision Oncology
• License: Creative Commons Attribution-ShareAlike 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.4103/JIPO.JIPO_22_19
• Title of Journal or Parent Work: Journal of Immunotherapy and Precision Oncology
• Volume: 3
• Issue: 1
• Start Page: 23
• End Page: 26
• Grant/Funding Information: Financial support and sponsorship: The authors disclosed no funding related to this article.
• Keywords: vascular endothelial growth factor; fibroblast growth factor; Bladder cancer; partial response; disease progression
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Oncology

Abstract

Metastatic urothelial carcinoma (mUC) has a poor prognosis with a 5-year survival probability of 4.8%. The mainstay of first-line treatment is platinum-based chemotherapy. Second-line therapy involves immune checkpoint inhibitors or a fibroblast growth factor receptor (FGFR) inhibitor, erdafitinib, for patients harboring selected FGFR alterations. Several additional agents are under development for the treatment of mUC. Recent studies demonstrate that ramucirumab and docetaxel have clinical activity in mUC. We report two patients with metastatic upper tract urothelial cancer (mUTUC) with FGFR alterations who were heavily pretreated with FGFR inhibitors that later showed response to ramucirumab and docetaxel. Preclinical studies indicate that FGF and VEGF pathways work synergistically, which could explain the observations in our patients. Our findings may represent another treatment option for patients with mUC and FGFR alterations who have progressed on multiple lines of therapy.