Management of metastatic bladder tumours

Urothelial cancer (UC) is among the most chemosensitive neoplasms of all the solid tumors. With multi-modality therapy for advanced disease, a subset of patients will achieve durable disease control. However, for the majority of patients with advanced disease, response durations to conventional treatment are relatively short. Recurrent UC tends to be very chemoresistant as highlighted by the modest response rates and poor outcomes with second-line treatment. Trials in both the first- and second-line settings have demonstrated that a ceiling in efficacy has likely been reached with cytotoxic drugs, particularly in unselected populations. Promising areas of investigation include integrating predictive biomarkers to optimize patient selection for specific systemic therapies, disrupting driving oncogenomic mutations and downstream signal transduction pathways, and co-targeting both tumor and the immune system or tumor stroma.