Developing Biomarkers and New Therapeutic Targets in Muscle Invasive Bladder Cancer

ABSTRACT

Muscle-invasive bladder cancer (MIBC) is classified into a heterogeneous life-threatening epithelial tumor with a high rate of metastasis and a dismal survival rate. Dissimilarity in genetic or epigenetic environment of MIBC causes considerable uncertainty in cancer aggressiveness, progression, and response rates, representing this cancer especially tough to manage. Several definite cases consist of point mutations in genes encoding receptor tyrosine or cytosolic kinases and alterations in epigenetics machinery, including both methylated genes and respective effector enzymes. Considering the highly aggressive and invasive character of MIBC, various attempts have been made to accurately detect and treat the disease using radical cystectomy alone or in combination with adjuvant chemo- and/or radiotherapy including neo-adjuvant chemotherapy. Nowadays advances in the field of immunotherapy with the introduction of checkpoint inhibitors have led to paradigm shifts in the treatment of MIBC. In current review, several published biological markers were introduced from diverse experimental techniques including gene expression profiling, mutations, single nucleotide polymorphisms, and epigenetic alterations. Moreover, the clinical evidence of new therapeutic targets with focus on checkpoint inhibitor in MIBC was summarized. These markers may be the excellent tools to predict MIBC prognosis and drug-responsiveness in the near future. (Korean J Urol Oncol 2020;181-10)