Predicting response to neoadjuvant chemotherapy in bladder cancer: controversies remain with genomic DNA sequencing

Neoadjuvant cisplatin-based chemotherapy (NAC) in muscle-invasive bladder cancer is an accepted standard of care (1,2). NAC improves patient outcomes quantified by a 5–8% higher 5-year overall survival (OS) and an increase of pathological downstaging of 10–15% (3-5). However, a considerable number of patients do not response to NAC. They are over treated and suffer from unnecessary adverse effects. This led biomarker researchers focus on the prediction of response to NAC (6-11), including the recently published study carried out by Plimack et al., which performed genomic DNA sequencing of pretreatment tumor tissue (12).