Precision Medicine to Treat Urothelial Carcinoma-The Way Forward

Abstract

The treatment of urothelial carcinoma (UC) is challenging given its molecular heterogeneity and variable response to current therapies. To address this, many tools, including tumor biomarker assessment and liquid biopsies, have been developed to predict prognosis and treatment response. Approved therapeutic modalities for UC currently include chemotherapy, immune checkpoint inhibitors, receptor tyrosine kinase inhibitors, and antibody drug conjugates. Ongoing investigations to improve the treatment of UC include the search for actionable alterations and the testing of novel therapies. An important objective in recent studies has been to increase efficacy while decreasing toxicity by taking into account unique patient and tumor-related factors-an endeavor called precision medicine. The aim of this review is to highlight advancements in the treatment of UC, describe ongoing clinical trials, and identify areas for future study in the context of precision medicine.

Keywords: biomarkers; immunotherapy; precision medicine; targeted therapy; urothelial carcinoma.

Figure 1

Precision medicine in urothelial carcinoma. TMB: tumor mutational burden; DDR: DNA damage response; CTC: circulating tumor cell; ctDNA: circulating tumor DNA; and FGFR: fibroblast growth factor receptor. Adapted from “Precision Cancer Therapy” by BioRender.com (2023). Retrieved from https://app.biorender.com/biorender-templates (accessed on 28 March 2023).

Figure 2

Current targeted therapies for urothelial carcinoma. CAR-T: chimeric antigen receptor therapy; PD-1: programmed cell death protein 1; PD-L1: programmed death-ligand 1; CTLA 4: cytotoxic T-lymphocyte-associated protein 4; ADC: antibody drug conjugate; ICI: immune checkpoint inhibitor; FGFR: fibroblast growth factor receptor; and VEGF: vascular endothelial growth factor. Created with BioRender.com (accessed on 28 March 2023).