Outcomes and response to therapy in bladder cancer. Are biomarkers of any help?

In oncology patients and clinicians are confronted with the search for measures which could help to elicit the individual patient's risk of future outcome, such as recurrence of disease after primary treatment, response to chemo-therapy or a general outline on the aggressiveness of a given lesion. In patient counselling, the emerging role of evidence based treatment choices reveals with cumulative certainty that the available information is inconclusive. This review will focus on current investigations of determinants to predict response to chemotherapy in advanced bladder cancer or to define prognosis of patients prior to any definite treatment. It will discuss the current evidence for the current systemic treatment options and highlight the many promising approaches of implementing markers either as a basis for a clinical decision in combination with other prognosticators (to better detect individuals at risk or to avoid unnecessary invasive procedures) or as a possible part of relevant pathways to be targeted. It will also discuss the role of biological markers with regards to the relevant clinical question and provide the current evidence to each field. It will highlight the need to further harmonize terminology, approaches and circumstances under which markers are evaluated and will provide suggestions for general methodological principles and guidelines for design, conduct, analysis and reporting of marker studies. The exploration of the current aspects of marker research may outline why collaborative, multicentre, and multidisciplinary efforts should be an integral part of future studies.