Therapeutic Opportunities in the Intrinsic Subtypes of Muscle-Invasive Bladder Cancer

Recent studies revealed that muscle-invasive bladder cancers segregate into intrinsic basal and luminal subtypes that are similar to those described for breast cancer. Each subtype is enriched with potentially clinically actionable genomic alterations and epigenetic signatures; there are associations between tumor subtype and sensitivity to conventional cisplatin-based chemotherapy. The authors review biological and clinical characteristics of the intrinsic subtypes and describe their implications for the development of conventional and targeted agents. The role that tumor plasticity seems to play in basal and luminal bladder cancer biology and its potential effects on the development of therapeutic resistance is also discussed.