Management of Muscle-invasive Bladder Cancer in the 2020s: Challenges and Perspectives

Area of Science:

• Oncology
• Urology
• Genetics

Background:

• Long-term survival rates for muscle-invasive bladder cancer (MIBC) have stagnated despite advances in chemotherapy.
• Detecting and treating micrometastatic disease remains a significant clinical challenge in MIBC management.

Purpose of the Study:

• To review strategies for integrating surgery, radiotherapy, and molecular-based systemic treatments for MIBC.
• To explore advancements in predicting micrometastatic disease using circulating tumor DNA and advanced imaging.
• To discuss the role of molecular classifiers and immuno-oncology in tailoring MIBC treatment.

Main Methods:

• Literature review focusing on multimodal treatment strategies for MIBC.
• Analysis of current diagnostic modalities for micrometastatic disease.
• Discussion of emerging therapeutic approaches including immuno-oncology and molecular profiling.

Main Results:

• Circulating tumor DNA and improved imaging show promise for predicting micrometastatic disease.
• Genetic subtypes of MIBC exhibit differential chemosensitivity, highlighting the need for molecular classification.
• Transurethral resection extent impacts treatment response rates in trimodal therapy (TMT) and neoadjuvant chemotherapy.

Conclusions:

• Effective management of micrometastatic disease is paramount for improving oncological outcomes in MIBC.
• A multidisciplinary approach combining surgery, radiotherapy, and molecular-based therapies is essential.
• Further development of molecular classifiers is needed for personalized clinical decision-making in MIBC.