Urothelial cancer is common and has ample lethal potential. However, most patients present before the disease is clinically beyond the bladder, and tools to interrogate the biologic potential of the urothelium would be expected to produce significant advances in the management of this disease. Likewise, the combination of available chemotherapy with surgery clearly results in an improved cure fraction for patients with locally advanced disease. Thus, significant improvements in overall mortality could be expected from better patient selection for systemic therapy and incremental advances in the activity of systemic therapy. To this end, the multichannel characterization of genomic and proteomic features of various clinical phenotypes, including benefit from existing therapies, dominates current research directions. In addition, the ready availability of the urothelium should provide an extremely valuable clinical research tool to investigate minimal residual disease, gene therapy, and other novel clinical directions that will be of substantial interest from the perspective of epithelial cancers generally.
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