The promise of molecular subtyping includes optimized surveillance of patients with bladder cancer, improved selection of treatment and increased understanding of cancer biology. At Aarhus University, they have noted different subtypes within the same tumor and clonal tumors have shown high levels of tumor heterogeneity.
Further work by their work assessed primary and metastatic tumors which similarly showed tumor heterogeneity highlighting an ‘evolution’ of the primary vs. metastatic tumors. Further heterogeneity is noted between sites of lesions. The question that remains is that does this additional knowledge of heterogeneity in primary versus metastatic lesions matter in the identification of subtypes and treatment efficacy prediction?
Finally, does tumor heterogeneity identification aid in clinical decision making? The use of ctDNA analysis for neoadjuvant chemotherapy response has been shown to be a useful measure of clinical response. Further research into predictors such as ctDNA of treatment response using the consensus classifier will hopefully elucidate heterogeneity and overall subtype impact in clinical decision-making. Moreover, cost containment and implementation with the dissemination of consensus subtyping need to be considered moving forward.
Presented by: Lars Dyrskjøt Andersen PhD, Professor, Aarhus University, Aarhus, Denmark
Written by: Stephen B. Williams, M.D., Associate Professor, Division of Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish M. Kamat, M.D. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX at the 16th Annual Meeting of the International Bladder Cancer Network (IBCN) October 11-13, 2018 - the Inntel Hotels Rotterdam Centre, Rotterdam, The Netherlands