Many advances in cancer treatment focus on strategies to identify characteristics in different individuals’ genetics and tumors that may be more likely to respond to specific therapeutic regimens. Researchers have been working to classify bladder cancer based on patterns of gene expression. Gene expression is the process in which information from a gene is used to create a product that performs an action within the body. Not all genes are expressed, and in cancer, genes can be expressed that should not be. Identifying patterns in gene expression can help develop promising therapies that are personalized and could improve treatment and be future indicators for prognosis and outcomes.
What are biomarkers and how can they help?
Biomarkers are measurable molecules found in the body that are indicators of normal or abnormal processes taking place. Abnormal processes that can be detected using biomarkers include disease, infection, or environmental impact. Biomarkers may also predict how the body will respond to particular disease treatments. Two biomarkers identified at the Mount Sinai health system in New York may aid doctors in focusing treatments for, and better defining prognoses for, people with the specific p53-like bladder cancer.1 P-53 is a gene that is often over-expressed in many cancer, so many treatments target this gene. Research results published in the journal Oncogene, suggest that the biomarkers could be predictive of patient outcomes. This knowledge, according to Dr. Jun Zhu, a professor of genetics and genomic sciences at Mount Sinai, can move the predictive nature of the prognosis of a condition forward.
The need for this research
Bladder cancer is the 4th most common cancer in men and the most common cancer of the urinary tract. Over 350,000 cases are reported annually worldwide.2 Bladder cancer, more common in men than in women, tends to affect people over age 55 with an average age at diagnosis older than 70.
Most bladder cancer is urothelial carcinoma, characterized by the uncontrolled growth of cancer cells in the urothelium. Most of the urinary tract, including the bladder, has a thin lining of urothelial cells. Urothelial carcinoma can also be referred to as transitional cell carcinoma. The different types of bladder cancer are classified as either non-muscle-invasive bladder cancer or muscle-invasive bladder cancer. These can be further divided into different molecular subtypes that have a unique response to chemotherapy. A precise diagnosis by a pathologist will guide the oncologist in recommending a personalized treatment targeted at each person’s unique cancer characteristics.3
Immunotherapy continues to be a promising area of research for treatment for bladder cancer. The immune system works to protect the body from disease and infection. Immunotherapy drugs, immune checkpoint inhibitors, target the body’s immune system as a partner in fighting cancer cells and have been approved for certain types of bladder cancer.
The biomarker study has identified p-53 as an aggressive type of muscle-invasive bladder cancer that is often resistant to traditional cisplatin chemotherapy.3 The research is intended to evaluate the way cells interact together, better understand the biology of tumors and influence their response to drug treatments. The ability to deactivate certain abnormal cellular pathways may play a role in restoring normal cell function and improving treatment outcomes. The research suggests integrating information about biomarkers into clinical decision-making and therapeutic implementation may advance the use and effectiveness of precision medicine into patient care.
Individual diagnosis and risk factors will continue to inform providers on recommended treatment plans, but the information can be enhanced based on clinical features of the condition, the disease subtype and gene expression patterns.
According to the American Cancer Society, the survival rate of muscle-invasive bladder cancer is around 63%. An aggressive form of bladder cancer, the cells may spread to other parts of the body at an increased rate. As noted, the success of conventional treatments like cisplatin varies. New approaches are needed to improve treatment outcomes for people with bladder cancer. Biomarkers can provide critical information and hope that customized treatment plans will improve clinical outcomes for p53-like bladder cancer.3
Weintraub, A. One step closer to personalized treatments for bladder cancer. Published July 6, 2018. https://www.fiercebiotech.com/research/one-step-closer-to-personalized-treatments-for-bladder-cancer. Accessed online July 11, 2018
Nagata, M., Mutu, S., Horie, S. Molecular Biomarkers in Bladder Cancer: Novel Potential Indicators of Prognosis and Treatment Outcomes. Published January 26, 2016. Dis Markers. 2016; 2016:8205836. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4746343/. Accessed online July 11, 2018.
Lee, E., Colazo-Lorduy, A, et al. Identification of microR-106b as a prognostic biomarker of p53-like bladder cancers by ActMiR. Published July 3, 2018. https://www.nature.com/articles/s41388-018-0367-0. Accessed online July 11, 2018.