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[Personalised medicine in urothelial bladder cancer].
- Source :
-
Aktuelle Urologie [Aktuelle Urol] 2019 Sep; Vol. 50 (5), pp. 502-508. Date of Electronic Publication: 2019 Jun 13. - Publication Year :
- 2019
-
Abstract
- Available treatment options and outcomes for patients suffering from urothelial bladder cancer, especially in the metastatic stage, have hardly improved over decades. However, the increasing use of high-throughput analyses and the concept of immune surveillance against tumours have recently changed our understanding of tumour biology in terms of tumour development and progression. Our knowledge of genetic mutations and molecular subtypes provides the possibility of tailor-made therapeutic approaches for patients suffering from bladder cancer. For example, changes in DNA repair signalling pathways are possible predictors of chemotherapy response, and targeted therapies using FGFR or PARP inhibitors are currently being tested in clinical trials. The extent to which molecular subtypes will find their way into clinical practice depends on the prospective evaluation of their prognostic and predictive value. The introduction of immune checkpoint inhibitors is probably the most significant expansion of available treatment options in bladder cancer. Despite their promising results, however, a lot of questions remain to be answered, as only 25 % of patients respond. Again, this highlights the need for predictive biomarkers. The large inter- and intratumoural heterogeneity represents a particular challenge for the clinical implementation of personalised treatment options in bladder cancer. All in all, some important steps towards personalised medicine in urothelial bladder cancer have been taken in the past few years, but, for the most part, their prospective evaluation is still pending.<br />Competing Interests: C.M. Grunewald: keine Interessenkonflikte G. Niegisch: Referententätigkeit: Pfizer Pharma GmbH (seit 2016), Pierre Fabre Pharma GmbH (2016), Roche Pharma AG (seit 2016), medac GmbH (seit 2017), Advisory Boards/beratende Tätigkeit: Roche Parma AG (seit 2015), IMS Health AG (seit 2016), BMS AG (2016)<br /> (© Georg Thieme Verlag KG Stuttgart · New York.)
- Subjects :
- Antineoplastic Combined Chemotherapy Protocols therapeutic use
B7-H1 Antigen genetics
Carcinoma, Papillary genetics
Carcinoma, Papillary pathology
Carcinoma, Transitional Cell genetics
Carcinoma, Transitional Cell pathology
Cisplatin administration & dosage
Combined Modality Therapy
Cystectomy
DNA Mutational Analysis
Humans
Immunotherapy methods
Neoplasm Invasiveness genetics
Neoplasm Metastasis
Prognosis
Urinary Bladder Neoplasms genetics
Urinary Bladder Neoplasms pathology
Carcinoma, Papillary therapy
Carcinoma, Transitional Cell therapy
Precision Medicine
Urinary Bladder Neoplasms therapy
Subjects
Details
- Language :
- German
- ISSN :
- 1438-8820
- Volume :
- 50
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Aktuelle Urologie
- Publication Type :
- Academic Journal
- Accession number :
- 31195416
- Full Text :
- https://doi.org/10.1055/a-0927-6725