[Predictive biomarkers in oncologic uropathology]

[Diagnostic and predictive markers in urinary tract cytology]

Multiprobe fluorescence in situ hybridization (FISH) still remains the gold standard for clarifying inconclusive atypia in urinary cytology in daily routine practice. The Paris Classification System (The Paris System, TPS) provides an important basis for the specific indication of FISH and emphasizes the importance of morphological correlation for an integrative approach to diagnosis. Next-generation sequencing technology in urinary specimens, which is highly sensitive for simultaneous detection of multiple genetic alterations, is also likely to play a diagnostic role in the near future.

[Predictive biomarkers in bladder cancer]

BACKGROUND

In the last few years, significant progress has been achieved in the therapeutic options for advanced urothelial bladder cancer.

OBJECTIVES

The aim of this work was to give an overview of the status and future perspective of the therapeutic options in this setting. Its focus is on the discussion of tissue-based therapy-predictive markers, which are evaluated through (molecular) pathology and thereby strengthening the role of pathology itself.

MATERIALS AND METHODS

Current (clinical study) data, the literature, and our own expertise were considered and summarized in the areas of therapy prediction of platinum-based chemotherapy, immunotherapy, and other therapeutic approaches.

RESULTS AND CONCLUSIONS

Molecular subtypes exhibit a predictive value both in platinum-based chemotherapy as well as in immunotherapy. However, further work is required to elucidate the predictive role of molecular subtypes in both settings. Changes in the DNA damage repair enzyme (DDR) genes, ERCC2, and ERBB2 as well as differences in the expression of EMMPRIN, survivin, and HMGA2 show promising results as further markers of chemotherapy efficacy. In the prediction of immunotherapy success, this mainly relates to the evaluation of the tumor mutation burden (TMB), tumor neoantigen burden (TNB), APOBEC signatures (MSig1; 3A/3B), and CD8-positive T‑effector cell signature. When using the fibroblast growth factor receptor (FGFR) inhibitor erdafitinib, which has not yet been approved in Germany, the evaluation of specific FGFR mutations and/or gene fusions by a companion diagnostic test is mandatory in the USA.