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Published on: October 30, 2013
Towards biomarker-driven therapies for urothelial carcinoma
Sara Coca Membribes1, Bernadett Szabados2, Thomas Powles3
1Barts Cancer Institute, Queen Mary University of London, Barts Health NHS Trust Biomedical Research Centre, London, UK. sara.membribes@nhs.net.
Abstract:
Molecularly targeted agents and immune checkpoint inhibitors (ICIs) are transforming the treatment landscape for patients with advanced-stage urothelial carcinoma (aUC), although trials testing these novel agents have shown mixed results. In this context, the identification of biomarkers has seen limited success: while activating mutations in FGFR3 are now established as an actionable biomarker to guide treatment with FGFR inhibitors, PD-L1 expression has shown inconsistent value as a predictive biomarker of response to ICIs. The identification of prognostic and predictive biomarkers for ICIs, antibody-drug conjugates and targeted therapies is an active area of research; promising candidates include tumour mutational burden and HER2 overexpression. In the past few years, circulating tumour DNA has emerged as a minimally invasive biomarker, with increasing data supporting its prognostic value and utility for monitoring clinical responses. In this Review, we address these developments and discuss biomarkers that could have clinical utility in patients with aUC.
Insights
Identifying new biomarkers is crucial for advancing urothelial carcinoma treatments. This review discusses promising candidates like circulating tumor DNA for targeted therapies and immune checkpoint inhibitors.
Area of Science:
- Oncology
- Genetics
- Immunology
Background:
- Advanced-stage urothelial carcinoma (aUC) treatment is evolving with molecularly targeted agents and immune checkpoint inhibitors (ICIs).
- Biomarker identification for these therapies has faced challenges, with inconsistent predictive value for PD-L1 expression.
- FGFR3 mutations are actionable biomarkers, but further prognostic and predictive markers are needed.
Purpose of the Study:
- To review current developments in biomarkers for advanced-stage urothelial carcinoma.
- To discuss potential clinical utility of emerging biomarkers for targeted therapies and ICIs.
Main Methods:
- Literature review of recent studies on biomarkers in urothelial carcinoma.
- Analysis of established and emerging biomarkers, including genetic mutations, protein expression, and circulating tumor DNA.
Main Results:
- FGFR3 mutations are validated biomarkers for FGFR inhibitors.
- Tumor mutational burden and HER2 overexpression show promise as predictive biomarkers.
- Circulating tumor DNA (ctDNA) is emerging as a valuable prognostic biomarker and for response monitoring.
Conclusions:
- Continued research into novel biomarkers is essential for optimizing treatment strategies in aUC.
- Circulating tumor DNA offers a minimally invasive approach for patient management.
- A multi-biomarker approach may be necessary for personalized treatment selection in aUC.
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