Thoughts on the shortage of vinflunine: could we have done more?

Vinflunine is indicated in monotherapy in adults with advanced or metastatic carcinoma of transitional cells of the urothelial tract previously treated with platinum derivatives.2 In June 2021, the supplier of vinflunine reported supply problems until March 2022. Vinflunine could have a role as second line therapy in stage IV relapsers for maintenance immunotherapy after first line treament with avelumab, if enfortumab-vedotin and erdafitinib are not available.3 4 Currently, alternatives are combinations of taxanes in selected patients or retreatment with platinum-based chemotherapy in the case of recurrence 1 year after previous treatment, when immunomodulatory therapy is not available.3 In other cases, discontinuation will be the only feasible option, something which will be difficult for those patients responding to treatment. Initiatives (inter-hospital networks for management of remaining stocks, coordination with oncology for stratification of candidate patients, etc) generated in this necessary debate will be part of the solution that we can offer the patient in this scenario.