Current and Emerging Strategies in Bladder Cancer
Giovanni Battista Di Pierro.
Urothelial cell carcinoma is one of the most common malignancies of the urinary tract. The standard of care, intravesical
chemo- and immunotherapy, while effective, is associated with a considerable side-effect profile and approximately 30% of patients
either fail to respond to treatment or suffer recurrent disease within 5 years. In the setting of muscle-invasive urothelial carcinoma, use of
neoadjuvant chemotherapy is associated with overall survival benefit. Muscle invasive bladder cancer is life threatening, showing modest
chemosensitivity, and usually requires radical cystectomy. Although bladder cancer is fairly well-genetically characterized, clinical trials
with molecularly targeted agents have, in comparison to other solid tumors, been few in number and largely unsuccessful. Hence, bladder
cancer represents a considerable opportunity and challenge for alternative therapies. In this review, we will focus on promising global or
pathway-based approaches (epigenetic modulators, kinase inhibitors, angiogenesis blockage, peroxisome proliferator-activated receptor γ
agonists, apoptosis inductors, virus therapy) supported by a deeper understanding of molecular biology of urothelial carcinoma, which
have been recently tested in clinical trials.
Keywords: Angiogenesis antagonists, Apoptosis agonists, Bladder cancer, Clinical studies, Epigenetic modulation, Intravesical therapy,
Kinase inhibitors, mTOR inhibitors, PPARγ agonists, Target therapy, Virus therapy
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