Locally advanced, muscle-invasive urothelial carcinoma of the bladder (MIBC) may be definitively
treated with either radiotherapy or radical cystectomy (RC) with urinary diversion. Neoadjuvant
chemotherapy (NAC) is typically administered prior to treatment with either modality. Receiving
NAC prior to RC might confer a survival advantage compared to undergoing RC alone. However, its
usefulness has been questioned due to concerns about over treatment and toxicity. Having the ability to
predict whether individual patients would benefit from or be harmed by NAC would be an important
tool in precision medicine. Unfortunately, to date no prognostic or predictive molecular markers have
been validated for this purpose. In this manuscript, we review the current state of molecular markers in
MIBC treatment and outline how recent advances in whole-genome sequencing may soon improve the
selection of precisely targeted therapeutics for the benefit of individual patients.
Keywords: Chemotherapy, molecular markers, prognosis, targeted therapy, urothelial carcinoma of the bladder.
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