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World Journal of Urology

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01-09-2019 | Topic Paper

Forty years of cisplatin-based chemotherapy in muscle-invasive bladder cancer: are we understanding how, who and when?

Authors: Julian Schardt, Beat Roth, Roland Seiler

Published in: World Journal of Urology | Issue 9/2019

Abstract

Purpose

For 40 years cisplatin-based chemotherapy has been administered to patients with muscle-invasive bladder cancer (MIBC). The best evidence of its efficacy is found in the context of neoadjuvant chemotherapy (NAC). However, the benefit to the patient is modest, with an improvement in 5-year overall survival of only 5–8%. Approximately 60% of patients still have muscle-invasive disease at cystectomy despite NAC. Selecting patients based on the likelihood of response appears to be a promising strategy to improve on this modest benefit. To realize this promise, researchers are investigating biomarkers for identifying responders and non-responders prior to NAC.

Methods

In this review, we discuss a number of tissue- and liquid-based biomarkers associated with the response to NAC.

Results and conclusions

We elaborate biomarkers at the methylation, DNA, RNA and protein levels and give their current status in clinical trials and/or their implementation in daily clinical practice. In particular, detection of alterations in DNA damage repair pathways as well as molecular subtypes seems to be a promising method for identifying responders to NAC. Furthermore, we illustrate liquid-based biomarkers. Circulating tumor DNA (ctDNA) in patient blood and urine appear to offer an elegant way for biological characterization of MIBC. Recent data show that the presence of ctDNA is limited in patients with localized MIBC being considered for NAC. At this disease stage, ctDNA in patient urine may be more promising for the genomic characterization of MIBC. However, ctDNA in blood or urine has not yet been rigorously investigated in this clinical context.

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Title: Forty years of cisplatin-based chemotherapy in muscle-invasive bladder cancer: are we understanding how, who and when?
Authors: Julian Schardt
Beat Roth
Roland Seiler
Publication date: 01-09-2019
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 9/2019
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-018-2544-8

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Springer Medicine

Forty years of cisplatin-based chemotherapy in muscle-invasive bladder cancer: are we understanding how, who and when?

Abstract

Purpose

Methods

Results and conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results and conclusions

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