Bladder cancer is a heterogeneous group of tumours with at least 40 histological subgroups. Patients with localized disease can be cured with surgical resection or radiotherapy, but such curative options are limited in the setting of recurrent disease or distant spread, in which case systemic therapy is used to control disease and palliate symptoms. Cytotoxic chemotherapy has been the mainstay of treatment for advanced bladder cancer, but high-quality evidence is lacking to inform the management of rare subgroups that are often excluded from studies. Advances in molecular pathology, the development of targeted therapies and the resurgence of immunotherapy have led to the reclassification of bladder cancer subgroups and rigorous efforts to define predictive biomarkers for cancer therapies. In this Review, we present the current evidence for the management of conventional, variant and divergent urothelial cancer subtypes, as well as non-urothelial bladder cancers, and discuss how the integration of genomic, transcriptomic and proteomic characterization of bladder cancer could guide future therapies.

Nature reviews. Urology. 2019 Jul 09 [Epub ahead of print]

Constantine Alifrangis, Ursula McGovern, Alex Freeman, Thomas Powles, Mark Linch

Department of Oncology, University College London Hospital, London, UK., Department of Pathology, University College London Hospital, London, UK., Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, UK., Department of Oncology, University College London Hospital, London, UK. .