Personalized Approaches in Bladder Cancer Treatment: A Clinical and Translational Research Perspective

Dear Colleagues,

Bladder cancer (BC) is the 10th most commonly diagnosed cancer worldwide. The majority of BC patients are diagnosed with low-stage, non-metastatic tumors and undergo curative transurethral resection (TUR). Following TUR, up to one-third of patients with pathological stages Ta and T1 progress to muscle-invasive bladder cancer (MIBC). Metastatic recurrence is reported in about one-fifth of patients who undergo curative transurethral resection of bladder tumor (TURBT). Approximately 25% of bladder cancer patients present with invasive or metastatic disease at the time of their initial diagnosis, and all of these patients require systemic therapy.

Methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) chemotherapy was introduced in the 1980s as a treatment for advanced or metastatic bladder cancer. In the late 1990s, gemcitabine and cisplatin (GC) chemotherapy—along with gemcitabine and carboplatin (GCarbo) for patients who are unfit for cisplatin—was introduced as an alternative treatment regimen for advanced or metastatic BC. These cytotoxic therapy regimens remained the primary treatment options for such patients for many years.

Recent years have seen significant advancements in bladder cancer treatment, including the introduction of immune checkpoint inhibitors (e.g., atezolizumab, pembrolizumab, and avelumab) and antibody–drug conjugates (ADCs) such as enfortumab vedotin (EV) and sacituzumab govitecan (SG). Despite these advancements, platinum-based chemotherapy drugs remain a cornerstone treatment for patients with advanced BC.

Intravesical instillations of Bacillus Calmette–Guérin (BCG) remain the treatment of choice for high-grade superficial BC, including carcinoma in situ (CIS). While the efficacy of BCG therapy is substantial, with 5-year recurrence-free survival rates ranging from 50% to 70%, patients who fail BCG treatment should undergo radical cystectomy to control the cancer.

Therefore, new advances in both systemic and local (intravesical) therapies are necessary. Given the growing number of available treatment options for BC, personalized or tailored therapy has become a key focus in optimizing patient outcomes.

This Special Issue aims at publishing up-to-date articles covering a broad range of basic, translational, and clinical research in the field of bladder cancer.

Dr. Vladimir Bilim
Guest Editor

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