Molecular Biomarkers for Guiding Bladder Preservation Therapy in Muscle-Invasive Bladder Cancer
This Lancet Oncology review examines emerging molecular biomarkers that may guide the choice between radical cystectomy and bladder preservation therapy in muscle-invasive bladder cancer. Advances in molecular profiling have identified genomic signatures and predictive biomarkers that could enable tailored patient selection based on tumour biology rather than clinicopathologic features alone. The authors highlight the need for prospective validation and the potential for combining biomarker-guided radiotherapy with immunotherapy.
The original study
Molecular biomarkers in bladder preservation therapy for muscle-invasive bladder cancer.
- Authors
- Miyamoto DT, Mouw KW, Feng FY, Shipley WU, Efstathiou JA
- Journal
- The Lancet. Oncology
- Type
- Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Review
- PMID
- 30507435
Original abstract
Although muscle-invasive bladder cancer is commonly treated with radical cystectomy, a standard alternative is bladder preservation therapy, consisting of maximum transurethral bladder tumour resection followed by radiotherapy with concurrent chemotherapy. Although no successfully completed randomised comparisons are available, the two treatment paradigms seem to have similar long-term outcomes; however, clinicopathologic parameters can be insufficient to provide clear guidance in the selection of one treatment over the other. Recent advances in the molecular understanding of bladder cancer have led to the identification of new predictive biomarkers that ultimately might help guide the tailored selection of therapy on the basis of the intrinsic biology of the tumour. In this Review, we discuss the existing evidence for molecular alterations and genomic signatures as prognostic or predictive biomarkers for bladder preservation therapy. If validated in prospective clinical trials, such biomarkers could enable the identification of subgroups of patients who are more likely to benefit from one treatment over another, and guide the use of combination therapies that include other modalities, such as immunotherapy, which might act synergistically with radiotherapy.