[Predictive biomarkers in bladder cancer]

Area of Science:

• Oncology
• Molecular Pathology
• Cancer Therapeutics

Background:

• Advanced urothelial bladder cancer treatment has seen significant therapeutic advancements.
• Personalized medicine approaches are increasingly important for optimizing patient outcomes.

Purpose of the Study:

• To provide an overview of current and future therapeutic options for advanced urothelial bladder cancer.
• To highlight the role of molecular pathology in identifying therapy-predictive markers.
• To emphasize the growing importance of pathology in guiding cancer treatment decisions.

Main Methods:

• Review of current clinical study data and existing literature.
• Inclusion of expert knowledge and own findings.
• Focus on therapy prediction for platinum-based chemotherapy, immunotherapy, and other treatments.

Main Results:

• Molecular subtypes demonstrate predictive value for both platinum-based chemotherapy and immunotherapy.
• Specific DNA damage repair (DDR) gene alterations (ERCC2, ERBB2) and gene expression markers (EMMPRIN, survivin, HMGA2) show promise for chemotherapy efficacy prediction.
• Tumor mutation burden (TMB), tumor neoantigen burden (TNB), APOBEC signatures, and CD8+ T-cell signatures are key for predicting immunotherapy response.

Conclusions:

• Molecular subtypes are valuable predictors of treatment response in urothelial bladder cancer.
• Further investigation is necessary to fully elucidate the predictive capabilities of molecular subtypes.
• Biomarkers such as DDR gene alterations, specific gene expressions, and immune signatures are crucial for personalized therapy selection.