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Platinum Priority – Collaborative Review – From Lab to Clinic
Editorial by XXX on pp. x–y of this issue

The Emergence of Precision Urologic Oncology: A Collaborative Review on Biomarker-driven Therapeutics

By: Christopher E. Barbieria b , Arul M. Chinnaiyanc, Seth P. Lernerd, Charles Swantone and Mark A. Rubina b f

European Urology, Volume 71 Issue 2, February 2017, Pages 237-246

Published online: 01 February 2017

Keywords: Precision Medicine, Mutations, Sequencing, Genomics

Abstract Full Text Full Text PDF (1,2 MB)

Abstract

Context

Biomarker-driven cancer therapy, also referred to as precision oncology, has received increasing attention for its promise of improving patient outcomes by defining subsets of patients more likely to respond to various therapies.

Objective

In this collaborative review article, we examine recent literature regarding biomarker-driven therapeutics in urologic oncology, to better define the state of the field, explore the current evidence supporting utility of this approach, and gauge potential for the future.

Evidence acquisition

We reviewed relevant literature, with a particular focus on recent studies about targeted therapy, predictors of response, and biomarker development.

Evidence synthesis

The recent advances in molecular profiling have led to a rapid expansion of potential biomarkers and predictive information for patients with urologic malignancies. Across disease states, distinct molecular subtypes of cancers have been identified, with the potential to inform choices of management strategy. Biomarkers predicting response to standard therapies (such as platinum-based chemotherapy) are emerging. In several malignancies (particularly renal cell carcinoma and castration-resistant prostate cancer), targeted therapy against commonly altered signaling pathways has emerged as standard of care. Finally, targeted therapy against alterations present in rare patients (less than 2%) across diseases has the potential to drastically alter patterns of care and choices of therapeutic options.

Conclusions

Precision medicine has the highest potential to impact the care of patients. Prospective studies in the setting of clinical trials and standard of care therapy will help define reliable predictive biomarkers and new therapeutic targets leading to real improvement in patient outcomes.

Patient summary

Precision oncology uses molecular information (DNA and RNA) from the individual and the tumor to match the right patient with the right treatment. Tremendous strides have been made in defining the molecular underpinnings of urologic malignancies and understanding how these predict response to treatment—this represents the future of urologic oncology.

Take Home Message

Precision medicine has the highest potential to impact the care of patients, and major strides have been made in urologic oncology. Prospective clinical trials will define reliable predictive biomarkers and new therapeutic targets leading to real improvement in patient outcomes.

Keywords: Precision Medicine, Mutations, Sequencing, Genomics.

Footnotes

a Department of Urology, Weill Cornell Medical College, New York, NY, USA

b Sandra and Edward Meyer Cancer Center of Weill Cornell Medical College, New York, NY, USA

c Michigan Center for Translational Pathology, Departments of Pathology and Urology, and Howard Hughes Medical Institute, University of Michigan Medical School, Ann Arbor, MI, USA

d Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA

e University College London Cancer Institute, Cancer Research UK Lung Cancer Centre of Excellence, London, UK

f Englander Institute for Precision Medicine, Weill Cornell Medical College, New York, NY, USA

Corresponding author. Weill Medical College of Cornell University, Urology, 525 East 68th Street, Starr 900, New York, NY 10065, USA. Tel. +12127465562; Fax: +1212 746 0975.

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