Understanding chemotherapy-induced changes in bladder cancer biology: a necessary step towards tailored treatment in cisplatin-refractory disease

Despite undeniable scientific progress, our growing understanding of the complex biology of bladder cancer still fails to translate into widely-available options for treatment personalization in this frequent disease. The now decades-old cisplatin-based chemotherapy remains the only gold standard for untreated disease at both the localized and metastatic stages. In muscle-invasive bladder cancer (MIBC), pathological response to cisplatin-based neoadjuvant chemotherapy (NAC) dichotomizes the patients into ~40% responders and ~60% non-responders, with dramatically decreased recurrence-free survival and overall survival in the latter (1). Thus, in recent years, while several teams and consortiums have published large-scale molecular characterization of untreated MIBC (2-5), they have also made notable efforts to describe the respective chemosensitivity of the various clusters and subtypes of bladder cancer. However, clinicians still lack to this day the routine molecular tools needed to identify the patients who will indeed benefit from NAC