Towards Personalized Medicine in Bladder Cancer

Dear Colleagues,

Bladder cancer is the 10th most common cancer type worldwide. There were more than 573,000 new cases of bladder cancer in 2020. It is the 13th most common cause of cancer death, with an estimated more than 212,000 deaths worldwide.

Urothelial carcinoma (UC) accounts for approximately 95% of all bladder cancers. Low-grade non-muscle-invasive bladder cancer (NMIBC) is usually successfully managed with transurethral resection (TUR), and overall survival for NMIBC reaches 90%, according to some reports. However, long-term survival for muscle-invasive bladder cancer (MIBC) and metastatic bladder cancer remains low. The standard-of-care treatment for MIBC and metastatic bladder cancer includes cystectomy with neoadjuvant/adjuvant chemotherapy, with or without radiation therapy. Platinum-based chemotherapy has been the first-line treatment for metastatic bladder cancer for more than two decades, but it is curative for only a small minority of patients. Combination therapy with methotrexate, vinblastine, adriamycin, and cisplatin (MVAC) results in a median survival of 13–15 months. Combination therapy with gemcitabine and cisplatin (GC) has shown less toxicity than MVAC and widely substituted MVAC in clinical practice. However, the efficacy of GC is similar to that of MVAC.

Treatment options for bladder cancer have undergone a rapid change in recent years. Immune checkpoint inhibitors (ICIs), targeted therapies, and antibody–drug conjugates are now available. As bladder cancer is genetically heterogeneous, the optimization of patient selection to identify those most likely to benefit from a specific therapy is an urgent issue in the treatment of patients with bladder cancer.

Dr. Vladimir Bilim
Guest Editor

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