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For three decades, the treatment of bladder cancer stood still. There were no new drugs and no improvements in diagnosis or survival rates. But all of that has changed, and now people with the disease and researchers have more options and hope. This Outlook discusses topics such as: how checkpoint-inhibitor drugs are helping those affected to survive for longer; why a healthy bladder is not sterile; and how the genetics of bladder cancer is revealing some surprising connections.
This Nature Outlook is editorially independent. It is produced with third party financial support. About this content.
The diagnostics, treatment and five-year survival rates for bladder cancer are largely unchanged since the 1990s. Research into cancer genomics, risk factors and immune therapies could hold the key to progress against this malignant disease.
Mechele Leon, an associate professor of theatre at the University of Kansas in Lawrence, was diagnosed with bladder cancer in March 2016. After treatment, Leon was left with no bladder, a urostomy bag, and a story to tell — which became a one-woman play called Bladder Interrupted.
Intravesical immunotherapy using BCG is the treatment approach for patients with high-risk and intermediate-risk non-muscle-invasive bladder cancer (NMIBC). However, recurrence and progression are a problem. In this Review, an expert group of authors from the International Bladder Cancer Group discuss the treatment options available after BCG failure and provide recommendations for optimal management of these patients.
Large-scale, next-generation sequencing collaborations have identified drivers and vulnerabilities of urothelial carcinoma. In this Review, the authors discuss the mutational landscape of urothelial carcinoma, including specific mutations in pathways and driver genes and describe how the next generation of therapies will be based on patient-specific targetable mutations observed in individual tumours.
In this Review, the authors describe the developing therapeutic landscape for patients with muscle-invasive bladder cancer. In particular, the data supporting the use of neoadjuvant cisplatin-based chemotherapy as a standard of care, the potential impact of genomic profiling on treatment approaches, and the emerging importance of immunotherapy are discussed.
Urothelial bladder cancer is one of the most common, and most deadly, malignant diseases worldwide. This Primer summarizes the current epidemiological and outcome data of patients with this disease, as well as describing how new molecular subtyping strategies might improve patient care in the future.