Do we have biomarkers to predict response to neoadjuvant and adjuvant chemotherapy and immunotherapy in bladder cancer?

Felix Wezel, Stefan Vallo, Florian Roghmann, Young Academic Urologist Urothelial Carcinoma Group of the European Association of Urology, Felix Wezel, Stefan Vallo, Florian Roghmann, Young Academic Urologist Urothelial Carcinoma Group of the European Association of Urology

Abstract

Radical cystectomy (RC) is the standard of care treatment of localized muscle-invasive bladder cancer (BC). However, about 50% of patients develop metastases within 2 years after cystectomy. Neoadjuvant cisplatin-based chemotherapy before cystectomy improves the overall survival (OS) in patients with muscle-invasive BC. Pathological response to neoadjuvant treatment is a strong predictor of better disease-specific survival. Nevertheless, some patients do not benefit from chemotherapy. The identification of reliable biomarkers enabling clinicians to identify patients who might benefit from chemotherapy is a very important clinical task. An identification tool could lead to individualized therapy, optimizing response rates. In addition, unnecessary treatment with chemotherapy which potentially leads to a loss of quality of life and which might also might cause a delay of cystectomy in a neoadjuvant setting could be avoided. The present review aims to summarize and discuss the current literature on biomarkers for the prediction of response to systemic therapy in muscle-invasive BC. Tremendous efforts in genetic and molecular characterization have led to the identification of predictive candidate biomarkers in urothelial carcinoma (UC), although prospective validation is pending. Ongoing clinical trials examining the benefit of individual therapies in UC of the bladder (UCB) by molecular patient selection hold promise to shed light on this question.

Keywords: Bladder cancer (BC); biomarker; chemotherapy; immunotherapy; urothelial carcinoma (UC).

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Overview on current taxonomy on molecular subtypes of urothelial bladder cancer and expected response to chemotherapy. MDA, the MD Anderson Cancer Center; UNC, the University of North Carolina; TCGA, The Cancer Genome Atlas; SCC, squamous cell carcinoma.

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