Molecular markers in bladder cancer

Abstract

Purpose Use of molecular markers in urine, tissue or blood offers potential opportunities to improve understanding of bladder cancer biology which may help identify disease earlier, risk stratify patients, improve prediction of outcomes or help target therapy. Methods A review of the published literature was performed, without restriction of time. Results Despite the fast-growing literature about the topic and the approval of several urinary biomarkers for use in clinical practice, they have not reached the level of evidence for widespread utilization. Biomarkers could be used in different clinical scenarios, mainly to overcome the limitations of current diagnostic, predictive, and prognostic tools. They have been evaluated to detect bladder cancer in asymptomatic populations or those with hematuria and in surveillance of disease as adjuncts to cystoscopy. There is also a potential role as prognosticators of disease recurrence, progression and survival both in patients with non-invasive cancers and in those with advanced disease. Finally, they promise to be helpful in predicting the response to local and/or systemic chemotherapy and/or immunotherapy. Conclusions To date, due to the lack of high-quality prospective trials, the level of evidence provided by the current literature remains low and, therefore, the potential of biomarkers exceeds utilization in clinical practice.

Circulating Tumor Cells Identify Patients with Super-High-Risk Non-Muscle-Invasive Bladder Cancer: Updated Outcome Analysis of a Prospective Single-Center Trial

“…Current models fail to accurately identify patients with NMIBC who are at the highest risk of progression to muscle‐invasive and/or metastatic disease, despite adjuvant treatment with BCG immunotherapy. Furthermore, we still lack biomarkers for the assessment of the biologic potential and clinical behavior of this complex disease, which could allow for a decisive improvement of patients’ outcomes . The results from this study suggest that in a subgroup of patients with HRT1 bladder cancer, CTCs might indicate a subclinical systemic disease.…”

Naturally-Occurring Invasive Urothelial Carcinoma in Dogs, a Unique Model to Drive Advances in Managing Muscle Invasive Bladder Cancer in Humans

“…The finding of differential treatment responses based on molecular InvUC subtypes (luminal, basal, etc.) along with combinations of these new drugs, is expected to lead to dramatic improvements in InvUC therapy (11)(12)(13)(14)(15)(16)(17)(18). There are, however, insufficient numbers of patients to test even a fraction of the new drugs, especially when considering various possible drug combinations, in order to optimize therapy.…”

“…Although in vitro systems, and carcinogen-induced, engraftment, and genetically-engineered mouse models are essential in bladder cancer research, they do not possess the collective features (cancer heterogeneity, molecular complexity, invasion, metastasis, immune cell response) that are crucial to predicting success or failure of emerging therapies in humans (19)(20)(21)(22)(23). With the resurgence of immunotherapy and the understanding that the immune system plays a major role in the outcomes of many types of therapies (16)(17)(18)(24)(25)(26)(27)(28)(29), it is especially critical that animal models possess a level of immunocompetence similar to that in human cancer patients. There is compelling evidence that dogs with naturally-occurring InvUC possess these collective features and can serve as a highly relevant animal model for the human condition to complement other models (30)(31)(32).…”

LncRNA CASC2 Plays an Indicative Role in Diagnosing Bladder Cancer

“…Currently, the early detection of bladder cancer mainly dependents on cystoscopy and voided urinary cytology. However, the clinical values are limited due to invasive and uncomfortable procedures, low sensitivity and high cost [20,21]. Therefore, the novel molecular biomarkers are in urgent need for early diagnosis of bladder cancer.…”