A Phase 3, Randomized, Double-Blind, Placebo-Controlled Study of Ramucirumab plus Docetaxel versus Placebo plus Docetaxel in Patients with Locally Advanced or Unresectable or Metastatic Urothelial Carcinoma Who Progressed on or after Platinum-Based Therapy.

1) Histologically or cytologically confirmed, locally advanced or unresectable or metastatic urothelial (transitional cell) carcinoma of the bladder, urethra, ureter, or renal pelvis. Patients with mixed pathology are eligible only if they have predominantly transitional cell tumor based on local pathology review.;2) Demonstrated disease progression while on a platinum-containing regimen in the first-line setting or within 14 months after completing the first-line platinum regimen. Patients who received treatment with one immune checkpoint inhibitor (for example PD-1, PDL1, CTLA4) regimen may have a longer interval since prior platinum-containing therapy (<=24 months), as noted in Inclusion Criterion [4].;3) A life expectancy of >=3 months, in the judgment of the investigator.;4) The patient has received no more than one prior systemic chemotherapy regimen in the relapsed or metastatic setting. Prior cytotoxic therapy in an adjuvant or neoadjuvant setting is not considered as a prior line of systemic chemotherapy in the relapsed or metastatic setting. Prior treatment with intravesicular chemotherapy, bacillus Calmette-Guérin (BCG), or platinum given as a radiation-sensitizing agent will not be considered as a systemic line of treatment. Prior treatment with no more than one prior immune checkpoint inhibitor is permitted and will not be considered as a line of systemic chemotherapy. Patients enrolling after immune checkpoint inhibitor therapy must have demonstrated disease progression while on that therapy or within 24 months after the last dose of that therapy.;5) Measurable disease or nonmeasurable but evaluable disease as defined by Response Evaluation Criteria in Solid Tumors, Version 1.1 ;6) Resolution, except where otherwise stated in the inclusion criteria, of all clinically significant toxic effects of prior chemotherapy, surgery, or radiotherapy to Grade <=1 by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE), Version 4.0.;7) Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.;8) The patient has adequate hematologic function and has not received blood or blood components transfusion within 2 weeks prior to the laboratory test.;9) Adequate coagulation function as defined by international normalized ratio (INR) <=1.5 and a partial thromboplastin time (PTT) <=1.5 × upper limit of normal (ULN) if not receiving anticoagulation therapy. Patients on full-dose anticoagulation must be on a stable dose of oral anticoagulant or low molecular weight heparin. If on warfarin, the patient must have an INR <=3 and have no active bleeding (defined as within 14 days prior to randomization, excluding trace hematuria) or pathological condition that carries a high risk of bleeding.;10) Adequate hepatic function as defined by bilirubin within normal limits (WNL), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) <=3.0 × ULN, and alkaline phosphatase (AP) <=2.5 × ULN.;11) The patient does not have:;• cirrhosis at a level of Child-Pugh B (or worse), or;• cirrhosis and a history of hepatic encephalopathy or clinically meaningful ascites resulting from cirrhosis. Clinically meaningful ascites is defined as ascites resulting from cirrhosis and requiring ongoing treatment with diuretics and/or paracentesis.;12) Adequate renal function as defined by creatinine clearance >30 mL/min either as measured by 24-hour urine collection or as calculated.;13) The patient*s urinary protein is <=1+ on dipstick or routine urinalysis; if urine protein >=2+, a 24-hour urine collection must demonstrate <2 g of protein in 24 hours.;14) The patient, if female, is surgically sterile, postmenopausal, or agrees to use a highly effective method of contraception during and for 12 weeks after the treatment period. The patient, if male, is surgically sterile or agrees to use a reliable method of contraception and to not donate sperm during and for 12 weeks after the treatment period or country requirements, whichever is longer.;15) The patient is able to provide signed informed consent and is amenable to compliance with protocol schedules and testing.;16) The patient is >=18 years of age ;17) The patient is willing to provide blood, urine, and tissue samples for research purposes. Submission of blood and urine specimens is mandatory for participation in this study, unless restricted per local regulations. If prior archived tumor specimens are available, and unless restricted by local regulations, submission of archived tumor tissue is mandatory. If an archived specimen is not available, submission of a newly acquired biopsy is requested when biopsy is safe and feasible.

18) The patient has received more than one prior systemic chemotherapy regimen for metastatic disease (except as noted in Inclusion Criterion [4]). A treatment regimen must consist of a minimum of 2 cycles to be considered as a prior regimen.;19) The patient has received prior systemic taxane therapy for TCC of the bladder, urethra, ureter, or renal pelvis in any setting (neoadjuvant, adjuvant, metastatic). Prior intravesical taxane therapy is allowed and will not be considered as a prior line of systemic therapy.;20) The patient has received more than one prior antiangiogenic agent (that is, bevacizumab, sorafenib, sunitinib) for TCC of the urothelium.;21) The patient has received radiation therapy (including full-dose pelvic radiotherapy) within 4 weeks prior to randomization or has not recovered from toxic effects of the treatment that was given >4 weeks prior to randomization. Single fraction radiotherapy for palliative bone stabilization within 4 weeks prior to randomization is allowed. If any tumor lesion is administered radiotherapy, then it cannot be considered for response assessment.;22) The patient has a history of uncontrolled hereditary or acquired bleeding or thrombotic disorders.;23) The patient has experienced a Grade >=3 bleeding event (for example, via gastric ulcers, gastric varices, rectal bleeding, or gross hematuria) within 3 months prior to randomization. Patients must have complete resolution of any prior bleeding event prior to randomization.;24) The patient has uncontrolled intercurrent illness, including, but not limited to symptomatic anemia, uncontrolled hypertension (>160 mm Hg systolic and/or >100 mm Hg diastolic, despite antihypertensive medication), symptomatic congestive heart failure, unstable angina pectoris, symptomatic or poorly controlled cardiac arrhythmia, psychiatric illness, or any other serious uncontrolled medical disorders in the opinion of the investigator.;25) The patient has experienced any arterial or venothrombotic or thromboembolic events, including, but not limited to myocardial infarction, transient ischemic attack, or cerebrovascular accident, within 6 months prior to randomization.;26) The patient has known untreated brain metastases, uncontrolled spinal cord compression, or leptomeningeal disease. (Note: A brain scan via computed tomography [CT] with contrast or magnetic resonance imaging [MRI] is to be performed only after study eligibility is confirmed, to detect the presence of intracranial metastasis.);27) The patient has an ongoing or active infection requiring antibiotic, antifungal, or antiviral therapy.;28) The patient has known human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome-related illness.;29) The patient has received a prior autologous or allogeneic organ or tissue transplantation.;30) The patient:;• received chemotherapy within 21 days prior to randomization; and/or;• is currently enrolled in, or discontinued within 21 days prior to randomization from, a clinical trial involving an investigational product (IP) or non-approved use of a drug or device, or is concurrently enrolled in any other type of medical research judged not to be scientifically or medically compatible with this study; and/or;• was treated with antiangiogenic therapy within 28 days prior to randomization.;31) The patient has undergone major surgery within 28 days prior to randomization or subcutaneous venous access device placement within 7 days prior to randomization.;32) The patient has had a serious nonhealing wound, ulcer, or bone fracture within 28 days prior to randomization.;33) The patient has an elective or planned major surgery to be performed during the course of the trial.;34) The patient is pregnant or lactating.;35) The patient has a concurrent malignancy or had another malignancy within 5 years of study enrollment (with the exception of adequately treated non-melanomatous skin cancer, in-situ cervical cancer, other noninvasive carcinoma or in situ neoplasm, or localized prostate cancer with no evidence of biochemical or clinical recurrence over a minimum of 6 months [>=6 months]).;36) The patient has an acute/subacute bowel obstruction or history of chronic diarrhea requiring ongoing medical intervention.;37) The patient has a history of gastrointestinal perforation and/or fistula within 6 months prior to randomization.;38) The patient has active diverticulitis.;39) The patient has a known hypersensitivity to docetaxel or other drugs formulated with polysorbate 80.;40) The patient has a known hypersensitivity to agents of similar biologic composition as ramucirumab, or other agents that specifically target VEGF.