Advances in risk stratification of bladder cancer to guide personalized medicine

Abstract

Bladder cancer is a heterogeneous disease that poses unique challenges to the treating clinician. It can be limited to a relatively indolent papillary tumor with low potential for progression beyond this stage to muscle-invasive disease prone to distant metastasis. The former is best treated as conservatively as possible, whereas the latter requires aggressive surgical intervention with adjuvant therapies in order to provide the best clinical outcomes. Risk stratification traditionally uses clinicopathologic features of the disease to provide prognostic information that assists in choosing the best therapy for each individual patient. For bladder cancer, this informs decisions regarding the type of intravesical therapy that is most appropriate for non-muscle-invasive disease or whether or not to administer neoadjuvant chemotherapy prior to radical cystectomy. More recently, tumor genetic sequencing data have been married to clinical outcomes data to add further sophistication and personalization. In the next generation of risk classification, we are likely to see the inclusion of molecular subtyping with specific treatment considerations based on a tumor’s mutational profile.

A Clinical Trial of the Intradermal TLR2 Agonist CADI-05 for BCG Recurrent and Unresponsive Non-Muscle Invasive Bladder Cancer

“…The major limitations of this study are 1) A single arm study with resected papillary disease 2) Not having patients with CIS and 3) Lower number of BCG unresponsive patients which included 6 patients with BCG refractory NMIBC [32,44]. Nevertheless, the durable success of CADI-05 in this clinically important group provides an impetus to proceed with further studies.…”

The Role of COL5A2 in Patients With Muscle-Invasive Bladder Cancer: A Bioinformatics Analysis of Public Datasets Involving 787 Subjects and 29 Cell Lines

“…MIBC is a subclass of bladder cancer that presents high risk for poor prognosis. The treatment of MIBC generally requires radical cystectomy and aggressive adjuvant therapy; however, conventional treatment has limited effects in many MIBC patients, and brings risks of severe complications and adverse effects (3, 5–7). To this end, developing novel treatment targeting MIBC, especially those based on a personalized strategy is of great importance.…”

“…In recent years, the incidence of BC has been increasing due to improved performance of detection strategies and population-aging (3). BCs are classified into two major distinct subgroups: non-muscle-invasive bladder cancer (NMIBC), and muscle-invasive bladder cancer (MIBC) (4, 5). NMIBCs often have a favorable prognosis following transurethral resection with or without intravesical chemotherapy or immunotherapy with Bacillus Calmette-Guérin (BCG).…”

ILC2s: New Actors in Tumor Immunity

“…Bladder cancer (BC) is broadly divided into two major stages: non-muscle-invasive (NMIBC) and muscle-invasive bladder cancer (MIBC) and is the ninth most common cancer worldwide (48). NMIBC standard treatment involves intravesical instillation of the Bacillus Calmette-Guérin antigen (BCG) (49), whereas MIBC treatment involves neoadjuvant cisplatin-based chemotherapy (NAC) followed by radical cystectomy (50). Despite these approaches, the rate of recurrence of BC remains high (51).…”