Can post-neoadjuvant therapy molecular classification guide future treatment selection for muscle-invasive bladder cancer?

While platinum based chemotherapy has been the backbone of systemic therapy for muscle invasive bladder cancer for decades, little is known about how this treatment changes the tumor phenotype, or if subsequent management decisions should be based on those changes. Seiler et al. present interesting data on clustering and classification of post-chemotherapy tumors. Their data support their model that chemotherapy is not simply selecting out resistant subclones but it is also inducing changes that may promote resistance and potentially vulnerabilities for subsequent therapy.