Dr. Gupta on Genomic Characterization of MIBC Histology to Predict Response

Shilpa Gupta, MD, assistant professor, Hematology Oncology and Transplantation Division, University of Minnesota, discusses genomic characterization of the histology of muscle invasive bladder cancer (MIBC) to predict treatment response.

Molecular subtypes in MIBC based on gene-expression profiling have led to physicians’ understanding of how a patient will respond to neoadjuvant cisplatin-based chemotherapy, Gupta says. GenomeDx is one such classifier. At the 2018 ASCO Annual Meeting, Gupta presented a case involving a patient with sarcomatoid bladder cancer, which is a rare disease. The patient received standard neoadjuvant chemotherapy and rapidly progressed, Gupta says. Within 4 weeks of surgery, the patient developed widespread metastases.

The patient was then put on pembrolizumab (Keytruda) and had a complete response. Researchers then looked at her genotyping from a previous biopsy and saw that she had high epithelial-to-mesenchymal transition and a low basal score, which explains why she did not respond to chemotherapy.