Honing the Hunt: A Comprehensive Review of Cell-free Tumor DNA to Predict Neoadjuvant Therapy Efficacy in Bladder Cancer

Caio V Suartz; Lucas Motta Martinez; Maurício D Cordeiro; Luiz A A Botelho; Fábio P Gallutti; José M Mota; Katia R M Leite; Paul Toren; William C Nahas; Leopoldo A Ribeiro-Filho

doi:10.1016/j.clgc.2024.102087

Honing the Hunt: A Comprehensive Review of Cell-free Tumor DNA to Predict Neoadjuvant Therapy Efficacy in Bladder Cancer

Clin Genitourin Cancer. 2024 Apr 6;22(3):102087. doi: 10.1016/j.clgc.2024.102087. Online ahead of print.

Affiliations

¹ Division of Urology, Institute of Cancer of São Paulo, University of São Paulo, Brazil; Division of Urology, Department of Surgery, CHU de Québec - Université Laval, Quebec City, QC, Canada. Electronic address: caio.v_suartz@hotmail.com.
² Division of Urology, Institute of Cancer of São Paulo, University of São Paulo, Brazil.
³ Genitourinary Medical Oncology Service, Institute of Cancer of São Paulo, University of São Paulo, Brazil.
⁴ Laboratory of Medical Investigation (LIM55), Urology Department, University of Sao Paulo Medical School, Sao Paulo, Brazil.
⁵ Division of Urology, Department of Surgery, CHU de Québec - Université Laval, Quebec City, QC, Canada.

PMID: 38688207
DOI: 10.1016/j.clgc.2024.102087

Abstract

Objective: To provide an updated view on the role of cell-free DNA as a predictor of pathological response to neoadjuvant therapy in patients with muscle-invasive bladder cancer.

Methods: A systematic review was conducted from September 2023 to October 2023. Selected studies from the MEDLINE and clinical trial databases were critically analyzed regarding the clinical efficacy of cell-free DNA as a predictive instrument after neoadjuvant therapy in bladder cancer. The methodological quality assessment was based on the QUADAS-2 tool.

Results: In this systematic review, we analyzed 5 studies encompassing a cumulative patient cohort of 780 individuals diagnosed with muscle-invasive bladder cancer, with a median follow-up ranging from 6 to 23 months. Among these studies, 4 primarily focused on detecting and analyzing circulating tumor DNA in plasma, while 1 study uniquely utilized cell-free tumor DNA in urine samples. The diagnostic accuracy of cell-free DNA in plasma ranges from 79% to 100%, indicating a variable yet significant predictive capability. In contrast, the study utilizing urinary cell-free DNA demonstrated an accuracy of 81% in predicting treatment response post-neoadjuvant chemotherapy.

Conclusion: Cell-free DNA is emerging as a valuable biomarker for predicting response to neoadjuvant chemotherapy in patients with muscle-invasive bladder tumors.

Keywords: Cell-free DNA; Circulating tumor DNA; Radical cystectomy; Systematic review.

Publication types

Review