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GU Cancers 2026 | Molecular subtyping in bladder cancer: luminal vs basal treatment insights

Vadim Koshkin, MD, University of California, San Francisco, CA, provides an overview of the molecular landscape of tumors and the classification of bladder cancer into subtypes, including luminal and basal subtypes, with further subcategories within these groups, as well as a neuroendocrine subtype. Certain subtypes, such as luminal, are more likely to express specific markers like nectin-4 and FGFR3 alterations, making them potential targets for existing therapies, while basal subtypes require additional treatment options. This interview took place at the 2026 ASCO GU Cancers Symposium in San Francisco, CA.

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Transcript

And that’s looking really at the molecular landscape and really the expression landscape in tumors and trying to basically classify them into groups, right? And these groups, you know, can correlate somewhat with the presence of variant histology, but it’s an imperfect correlation at best. Generally speaking, when we split patients into these molecular subtypes, there are luminal versus basal subtypes...

And that’s looking really at the molecular landscape and really the expression landscape in tumors and trying to basically classify them into groups, right? And these groups, you know, can correlate somewhat with the presence of variant histology, but it’s an imperfect correlation at best. Generally speaking, when we split patients into these molecular subtypes, there are luminal versus basal subtypes. This is, you know, classification that initially comes from breast cancer, but it’s been at least somewhat adopted in bladder cancer as well. But there, as a broader pattern of classification, there are now even different subtypes within luminal, within basal. There’s also a separate neuroendocrine subtype. What we see is that, again, with luminal subtypes, there is more probably nectin-4 expression. There’s more of some of the other relevant alterations like FGFR3 alterations. Also, probably HER2 expression potentially is higher there. And most of our currently available therapies, certainly targeted therapies, would probably be directed at those subsets. Patients with a basal subtype are certainly in need of additional treatments and additional options. This is, again, just maybe a more general overview of this. I would say in clinic right now, we don’t really use this to make decisions. But I think this is, you know, subtyping these tumors is, you know, potentially an important future approach that we should really kind of investigate in, prospectively investigate in clinical trials to see if there is a, well, a reliable way to identify patients who, again, based on molecular subtyping, who can respond to certain therapies versus those who won’t and where we should consider other options.

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