Precision medicine for urothelial carcinoma: An international perspective
Mariane S Fontes1, Daniel Vargas Pivato de Almeida2, Flavio Cárcano3
1Division of Genitourinary Medical Oncology, Oncoclínicas, Rio de Janeiro, Brazil; LAGOG-Latin American Cooperative Oncology Group, Porto Alegre, Brazil.
Abstract:
The treatment landscape of urothelial cancers has evolved in the last decade with the approval of chemotherapy, immune checkpoint inhibitors, targeted therapies, and antibody drug conjugates. Although improvements in response and survival have been achieved with these strategies, in some scenarios their benefit is still questionable. Current efforts to identify prognostic and predictive biomarkers are crucial for better patient selection and treatment outcomes. In this paper we will review the most promising biomarkers under investigation, such as molecular classifiers, genomic alterations, programmed cell death ligand 1 expression, tumor mutational burden, circulating tumor DNA, urinary biomarkers among others, for muscle invasive bladder cancer and metastatic urothelial cancers. Deeper understanding of these biomarkers will aid clinical decision-making and help tailor treatment strategies.
Insights
Identifying new biomarkers is key to improving urothelial cancer treatment. This review covers promising prognostic and predictive markers for bladder cancer, aiming to enhance patient selection and outcomes.
Area of Science:
- Oncology
- Translational Research
Background:
- The treatment of urothelial cancers has advanced with new therapies like chemotherapy, immune checkpoint inhibitors, targeted drugs, and antibody-drug conjugates.
- Despite progress, treatment benefits are not universal, highlighting the need for better patient stratification.
Purpose of the Study:
- To review promising prognostic and predictive biomarkers for urothelial cancers.
- To guide clinical decision-making and personalize treatment strategies for muscle-invasive and metastatic urothelial cancers.
Main Methods:
- Literature review of current and emerging biomarkers.
- Focus on molecular classifiers, genomic alterations, PD-L1 expression, tumor mutational burden, ctDNA, and urinary biomarkers.
Main Results:
- Several biomarkers show potential for predicting treatment response and patient outcomes.
- Biomarker research is essential for optimizing the use of existing and novel urothelial cancer therapies.
Conclusions:
- A deeper understanding of these biomarkers will facilitate personalized medicine in urothelial cancer.
- Biomarker-driven approaches are crucial for improving treatment efficacy and patient selection in bladder and urothelial cancers.
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