Urothelial cancer is a common malignancy of the bladder with a highly invasive and metastatic potential to the adjacent muscle tissue and/or to other parts of the body. It is considered the sixth most common cancer in the USA, with most cases being men, while 50% of patients ultimately die of metastatic disease. Although urothelial cancer management has made tremendous leaps in the last 40 years with various forms of treatment modalities (surgery, cisplatin-based chemotherapy, neoadjuvant or adjuvant chemotherapy, radio-sensitizing chemotherapy, radiotherapy and their combinations) being implemented, they still raise serious questions concerning their efficacy, toxicity and the resulting quality of life of patients. Furthermore, even though new promising therapies, such as immunotherapy and targeted therapies, are currently being developed, widely accepted criteria for patient selection and individualizing treatment are still limited.
To this aim, theranostics offers a platform which allows disease diagnosis, treatment and monitoring, through the molecular and imaging subtyping of urothelial cancer, while at the same time being cost-effective and of significant clinical value. -omics and multi-omics strategies (pharmacogenomics, metabolomics, proteomics/peptidomics) allow for the analysis of data on several key molecules involved in tumour biology, through the integration of information technologies in order to successfully delineate their impact on disease on multiple levels. In this review, we analyse in detail data concerning the most studied of them as well as their current clinical applications. Namely, we present available data on VEGF, ET-1, gene models, CAIX, p53, DNA ploidy, PD-1/PD-L1 and mutation load, Wnt and FGF gene clusters and HER2. At the same time, theranostic imaging (molecular imaging biomarkers) offers a complementary approach to -omics strategies for addressing tumour heterogeneity and providing a visualized unique cancer signature in a non-invasive way, while enabling the development of effective targeted therapies. No doubt, if precision medicine in the treatment of urothelial cancer is envisaged, theranostic imaging remains to be explored.
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We believe that -omics technologies coupled to imaging modalities constitute an important toolbox in researchers’ and clinicians’ hands to improve long-term overall and disease-free survival rates, without compromising the quality of life of urothelial cancer patients. Although optimal patient selection still remains elusive, molecular and imaging theranostics can pave the way towards delineation of disease heterogeneity, patient stratification and tailor-made disease management in urothelial cancer.
Theodora Katsila1,2,*, Michalis Liontos3, Angeliki Panagiotara1, George P. Patrinos2,4, Aristotelis Bamias3, Dimitrios Kardamakis1,5
1Laboratory of Radiobiology, Department of Radiation Oncology, University of Patras Medical School, Patras, Greece
2Department of Pharmacy, University of Patras, Patras, Greece
3Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
4Department of Pathology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
5Department of Radiation Oncology, University of Patras Medical School, Patras, Greece
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