Vinflunine

Vinflunine was authorised by the European Commission in September 2009 as monotherapy for advanced or metastatic transitional cell carcinoma of the urothelial tract after failure of a prior platinum-containing regimen, on a phase 3 trial of 370 patients against best supportive care in which median overall survival improved modestly and significantly in the eligible population, making it the first drug with level 1 evidence in second-line urothelial cancer. It is not approved in the US, where the FDA declined the application. Pembrolizumab, enfortumab vedotin and erdafitinib have since displaced it in most guidelines, but it remains an option where immunotherapy is unsuitable. Neutropenia, constipation (prophylactic laxatives are recommended), fatigue and QT prolongation are the main adverse effects. Marketed by Pierre Fabre.