Would you share about the current status of targeted therapies for bladder cancer?

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GarySteinbergMD (Physician - Urology (Verified) ) - 08 / 22 / 2012

Platinum based chemotherapy i.e. Cis Platin is commonly used for the treatment of locally advanced and metastatic bladder cancer. In addition, Platinum based chemotherapy is used in the neoadjuvant (before radical cystectomy) and adjuvant setting (after radical cystectomy); however, presently there are no known biomarkers of disease response. Improving survival will require newer medications and moving beyond conventional histological staging and grading of tumors. Currently, chemotherapy for bladder cancer is the approach of “one size fits all”. However, we know that cancer is a diverse, complex heterogeneous process with multiple mutations and altered metabolic and genetic pathways. The goal of TCGA for bladder cancer is to perform complete genomic analysis of 500+ invasive bladder cancers to determine the various “genetic signatures” and altered metabolic pathways associated with bladder cancer. Ideally this will lead to new prognostic markers as well as therapeutic targets for novel and personalized drug development. Single gene markers such as p53, pRb, p16, p21, ERCC1, RRM1, hENT1, PTEN, pErb, Her2 Neu as well as microRNA markers have all been studied as prognostic predictors of survival as well as markers for chemotherapy responsiveness. To date clinical trials are ongoing to test agents that target the fibroblast, epidermal and vascular endothelial growth factor pathways. The goal is to augment cytotoxic chemotherapy with these targeted therapies; however, at present much work on the biology of bladder cancer is required.
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