Stenzl - Figure 23
Molecular Subtypes
FIG. 23: The advantage of the MD Anderson classification is not only that it gives some indications about prognosis and survival, but it also demonstrates that the molecular subtype of p53-like carcinomas is less sensitive to neoadjuvant chemotherapy, whereas neoadjuvant chemotherapy seems to be more effective in the basal subtype.[5,18] This classification goes even further in that it shows that the p53-like carcinoma cell group will be expanded after neoadjuvant chemotherapy, and so p53 may change the phenotype.
We will return to this later, but this is a nice intimation that there are certain tumors that are chemoresistant and those are the ones that will benefit from application of cisplatin-based chemotherapy. Other tumors do not benefit from neoadjuvant chemotherapy, and for these it may be more prudent, given the current systemic therapy that is available, to go to definitive cystectomy firsthand.
References
Choi W, Porten S, Kim S, et al. Identification of distinct basal and luminal subtypes of muscle-invasive bladder cancer with different sensitivities to frontline chemotherapy. Cancer Cell. 25, 152–65 http://dx.doi.org/10.1016/j.ccr.2014.01.009
Choi W, Czerniak B, Ochoa A, et al. Intrinsic basal and luminal subtypes of muscle-invasive bladder cancer. Nature Rev Urol. 2014;11:400–10. doi:10.1038/nrurol.2014.129
