The management of metastasic or recurrent vaginal cancer is not standardized, with emerging evidence supporting the integration of immunotherapy and targeted therapies into treatment paradigms.The shared mechanisms of tumor progression between cervical and vaginal cancers, particularly regarding PD-L1 expression and VEGF-driven angiogenesis, provide a strong foundation for extending the use of bevacizumab and pembrolizumab to vaginal cancer. The gene discussed is VEGFA; the disease is neoplasm.