Imagine a room full of patients with muscle-invasive bladder cancer. Which of them should get presurgical (neoadjuvant) chemotherapy? The answer right now is, “all of them” – but that’s not the best answer.

“Although neoadjuvant chemotherapy is recommended for everyone with muscle-invasive bladder cancer, it only benefits a subset of those patients ,” says David McConkey, Ph.D., the Erwin and Stephanie Greenberg Professor of Urology and Director of the Johns Hopkins Greenberg Bladder Cancer Institute; he is also Chair for Translational Medicine in the genitourinary division of the Southwest Oncology Group (SWOG). Together with Woonyoung Choi, M.S., Ph.D., McConkey is leading a nationwide effort to validate several panels of biomarkers. The biomarkers test for basal and luminal molecular subtypes of bladder cancer, and also for mutations in DNA damage repair genes, in tumors that were collected from patients enrolled in the SWOG’s Phase 2 clinical trial comparing gemcitabine/cisplatin and MVAC chemotherapy.

“If the tests are validated, they will enable clinicians to use pretreatment biopsies to identify the subset of patients who will receive benefit, sparing the ones who will not,” McConkey notes. “This would dramatically change clinical practice.”