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Molecular Subtypes as a Basis for Stratified Use of Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer—A Narrative Review

Sjödahl, Gottfrid LU ; Abrahamsson, Johan LU ; Bernardo, Carina LU orcid ; Eriksson, Pontus LU ; Höglund, Mattias LU and Liedberg, Fredrik LU (2022) In Cancers 14(7). p.1-17
Abstract

There are no established biomarkers to guide patient selection for neoadjuvant chemotherapy prior to radical cystectomy for muscle-invasive bladder cancer. Recent studies suggest that molecular subtype classification holds promise for predicting chemotherapy response and/or survival benefit in this setting. Here, we summarize and discuss the scientific literature examining transcriptomic or panel-based molecular subtyping applied to neoadjuvant chemotherapy-treated patient cohorts. We find that there is not sufficient evidence to conclude that the basal subtype of muscle-invasive bladder cancer responds well to chemotherapy, since only a minority of studies support this conclusion. More evidence indicates that luminal-like subtypes may... (More)

There are no established biomarkers to guide patient selection for neoadjuvant chemotherapy prior to radical cystectomy for muscle-invasive bladder cancer. Recent studies suggest that molecular subtype classification holds promise for predicting chemotherapy response and/or survival benefit in this setting. Here, we summarize and discuss the scientific literature examining transcriptomic or panel-based molecular subtyping applied to neoadjuvant chemotherapy-treated patient cohorts. We find that there is not sufficient evidence to conclude that the basal subtype of muscle-invasive bladder cancer responds well to chemotherapy, since only a minority of studies support this conclusion. More evidence indicates that luminal-like subtypes may have the most improved outcomes after neoadjuvant chemotherapy. There are also conflicting data concerning the association between biopsy stromal content and response. Subtypes indicative of high stromal infiltration responded well in some studies and poorly in others. Uncertainties when interpreting the current literature include a lack of reporting both response and survival outcomes and the inherent risk of bias in retrospective study designs. Taken together, available studies suggest a role for molecular subtyping in stratifying patients for receiving neoadjuvant chemotherapy. The precise classification system that best captures such a predictive effect, and the exact subtypes for which other treatment options are more beneficial remains to be established, preferably in prospective studies.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
basal, biomarker, bladder cancer, chemotherapy, cisplatin, luminal, molecular subtypes, neoadjuvant, response, urothelial carcinoma
in
Cancers
volume
14
issue
7
article number
1692
pages
1 - 17
publisher
MDPI AG
external identifiers
  • pmid:35406463
  • scopus:85127049703
ISSN
2072-6694
DOI
10.3390/cancers14071692
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland.
id
4dbd5657-e510-4502-8485-bbcce6fc8b91
date added to LUP
2022-04-19 21:57:11
date last changed
2025-01-14 04:27:22
@article{4dbd5657-e510-4502-8485-bbcce6fc8b91,
  abstract     = {{<p>There are no established biomarkers to guide patient selection for neoadjuvant chemotherapy prior to radical cystectomy for muscle-invasive bladder cancer. Recent studies suggest that molecular subtype classification holds promise for predicting chemotherapy response and/or survival benefit in this setting. Here, we summarize and discuss the scientific literature examining transcriptomic or panel-based molecular subtyping applied to neoadjuvant chemotherapy-treated patient cohorts. We find that there is not sufficient evidence to conclude that the basal subtype of muscle-invasive bladder cancer responds well to chemotherapy, since only a minority of studies support this conclusion. More evidence indicates that luminal-like subtypes may have the most improved outcomes after neoadjuvant chemotherapy. There are also conflicting data concerning the association between biopsy stromal content and response. Subtypes indicative of high stromal infiltration responded well in some studies and poorly in others. Uncertainties when interpreting the current literature include a lack of reporting both response and survival outcomes and the inherent risk of bias in retrospective study designs. Taken together, available studies suggest a role for molecular subtyping in stratifying patients for receiving neoadjuvant chemotherapy. The precise classification system that best captures such a predictive effect, and the exact subtypes for which other treatment options are more beneficial remains to be established, preferably in prospective studies.</p>}},
  author       = {{Sjödahl, Gottfrid and Abrahamsson, Johan and Bernardo, Carina and Eriksson, Pontus and Höglund, Mattias and Liedberg, Fredrik}},
  issn         = {{2072-6694}},
  keywords     = {{basal; biomarker; bladder cancer; chemotherapy; cisplatin; luminal; molecular subtypes; neoadjuvant; response; urothelial carcinoma}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{1--17}},
  publisher    = {{MDPI AG}},
  series       = {{Cancers}},
  title        = {{Molecular Subtypes as a Basis for Stratified Use of Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer—A Narrative Review}},
  url          = {{http://dx.doi.org/10.3390/cancers14071692}},
  doi          = {{10.3390/cancers14071692}},
  volume       = {{14}},
  year         = {{2022}},
}