Predicting Response to Neoadjuvant Chemotherapy in Bladder Cancer
Giovanni Motterle1, Jack R Andrews2, Alessandro Morlacco3
1Department of Urology, Mayo Clinic, Rochester, MN, USA; Department of Surgery, Oncology and Gastroenterology-Urology, Padova, Italy.
Identifying nonresponders to neoadjuvant chemotherapy (NAC) before bladder cancer surgery is crucial. Current methods lack predictive power, with molecular tumor analysis showing the most promise for future personalized treatment strategies.
Area of Science:
- Urology
- Oncology
- Medical Imaging
Background:
- Neoadjuvant chemotherapy (NAC) improves survival for muscle-invasive bladder cancer but is ineffective for some patients.
- Identifying nonresponders avoids unnecessary toxicity and surgical delays.
Purpose of the Study:
- To review current evidence on predictors of NAC response in muscle-invasive bladder cancer.
- To identify factors that can predict treatment outcomes before or during NAC.
Main Methods:
- Comprehensive literature search of MEDLINE, Embase, and Cochrane Library.
- Inclusion of studies evaluating clinical, pathological, molecular, and imaging predictors of NAC response.
Main Results:
- General patient characteristics and standard imaging have limited predictive value.
- Advanced MRI techniques show potential, but require further validation.
- Molecular tumor characterization offers the most promising avenue for predicting NAC response.
Conclusions:
- No validated tool currently exists to predict NAC response in bladder cancer.
- Further research is needed before a paradigm shift in treatment selection can be recommended.
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