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Neoadjuvant therapy in muscle-invasive bladder cancer: a model for rational accelerated drug development
Arjun V Balar1, Matthew I Milowsky2
1Genitourinary Cancers Program, Perlmutter NYU Cancer Center, 160 East 34th Street, 8th Floor, New York, NY 10016, USA.
Abstract:
Since the advent of cisplatin-based combination therapy in the management of muscle-invasive and advanced bladder cancer, there has been little progress in improving outcomes for patients. Novel therapies beyond cytotoxic chemotherapy are needed. The neoadjuvant paradigm lends to acquiring ample pretreatment and posttreatment tumor tissue as a standard of care, which enables comprehensive biomarker analyses to better understand mechanisms of both response and resistance, which will aid drug development. This article discusses the evolution of neoadjuvant therapy as standard treatment and the role it may serve toward the development of novel therapies.
Insights
Cisplatin therapy for advanced bladder cancer has stalled progress. The neoadjuvant approach offers tumor tissue for biomarker analysis, crucial for developing new drug therapies beyond chemotherapy.
Area of Science:
- Urology
- Oncology
- Cancer Research
Background:
- Cisplatin-based combination therapy has been the standard for muscle-invasive and advanced bladder cancer for decades.
- Despite its use, significant improvements in patient outcomes remain limited.
- There is a critical need for novel therapeutic strategies beyond traditional cytotoxic chemotherapy.
Purpose of the Study:
- To discuss the evolution of neoadjuvant therapy in bladder cancer treatment.
- To highlight the role of neoadjuvant therapy in facilitating biomarker discovery.
- To explore how neoadjuvant treatment can aid in the development of novel drugs.
Main Methods:
- Review of the current landscape of neoadjuvant therapy in bladder cancer.
- Analysis of the potential of neoadjuvant treatment to yield pre- and post-treatment tumor tissue.
- Discussion of how comprehensive biomarker analyses can inform drug development.
Main Results:
- The neoadjuvant paradigm provides a unique opportunity for extensive tumor tissue collection.
- Biomarker analyses from this tissue can elucidate mechanisms of treatment response and resistance.
- This approach is vital for advancing the development of new bladder cancer therapies.
Conclusions:
- Neoadjuvant therapy is evolving as a standard treatment for bladder cancer.
- The collection of tumor tissue during neoadjuvant treatment is essential for biomarker research.
- This strategy holds significant promise for accelerating the development of novel therapeutic agents.
