Waiting in the wings: the emerging role of molecular biomarkers in bladder cancer

Abstract

Bladder cancer (BCa) is the fifth most frequently diagnosed cancer worldwide and is, in fact, the most expensive cancer on a per-patient to treat basis. There is a critical need to implement new tests into clinical practice to improve the quality of clinical care, decrease unnecessary invasive therapies and ultimately save costs. Currently, no molecular or genetic biomarker has been widely integrated into daily clinical practice. However, major milestones have been achieved in our understanding of the molecular alterations in BCa that will provide the basis for integrating molecular and genetic biomarkers into clinical decision making to guide management. Clinical implementation of such novel molecular and genetic concepts is the cornerstone in an effort to usher the age of precision medicine into patient care. Areas covered: In this review, the authors discuss the emerging role of molecular biomarkers in patients receiving BCG immunotherapy as well as neoadjuvant and adjuvant chemotherapy in BCa. Expert commentary: Molecular predictive and prognostic biomarkers in BCa are promising diagnostic options that will pave the way for molecular-based personalized medicine.

Subcellular Localization of uc.8+ as a Prognostic Biomarker in Bladder Cancer Tissue

“…Numerous publications have suggested that lncRNAs, such as UCA-1, MALAT1, PANDAR and so on, play key roles in development and progression of bladder cancer [4]. Nevertheless, their clinical use is still limited and none is yet validated or widely used in the clinical practice [5].…”

Prognostic Role of Preoperative Vascular Cell Adhesion Molecule-1 Plasma Levels in Urothelial Carcinoma of the Bladder Treated With Radical Cystectomy

“…Third, because of the recruitment time for this study, no information was available on the predictive value of VCAM-1 with respect to immunotherapies or NAC. Finally, although next-generation sequencing and immunohistology have shown several other candidate biomarkers, the results often are limited in reproducibility because of cost, intratumor heterogeneity, absence of a standardized approach, and overall complexity, 29,30 hindering their implementation into clinical practice. Therefore, given the ease of procurement, low cost, high sample homogeneity, and the potential to improve early outcome prediction and prognosis, VCAM-1 warrants further evaluation as a candidate biomarker for integration into prospective clinical trials.…”

The Value of Preoperative Plasma VEGF Levels in Urothelial Carcinoma of the Bladder Treated with Radical Cystectomy

“…In addition, when combined with tissue levels of VEGF expression in transurethral resection (TUR) specimens, it might help in preoperative patient counseling. While next-generation sequencing and immunohistochemical staining have suggested several other candidate tissue biomarkers, such results are often limited in reproducibility because of to their cost, intratumoral heterogeneity, the absence of a standardized approach for their handling, and the overall complexity of the evaluation process [29,30]; thus, their implementation in clinical practice remains hampered. Unlike classical clinicopathological parameters that can be assessed only postoperatively, VEGF could be used for preoperative risk stratification and could result in more efficient delivery of neoadjuvant systemic therapy.…”