• Christopher E Barbieri, Arul M Chinnaiyan, Seth P Lerner, Charles Swanton, and Mark A Rubin.
• Department of Urology, Weill Cornell Medical College, New York, NY, USA; Sandra and Edward Meyer Cancer Center of Weill Cornell Medical College, New York, NY, USA. Electronic address: chb9074@med.cornell.edu.
• Eur. Urol. 2017 Feb 1; 71 (2): 237-246.

ContextBiomarker-driven cancer therapy, also referred to as precision oncology, has received increasing attention for its promise of improving patient outcomes by defining subsets of patients more likely to respond to various therapies.ObjectiveIn this collaborative review article, we examine recent literature regarding biomarker-driven therapeutics in urologic oncology, to better define the state of the field, explore the current evidence supporting utility of this approach, and gauge potential for the future.Evidence AcquisitionWe reviewed relevant literature, with a particular focus on recent studies about targeted therapy, predictors of response, and biomarker development.Evidence SynthesisThe recent advances in molecular profiling have led to a rapid expansion of potential biomarkers and predictive information for patients with urologic malignancies. Across disease states, distinct molecular subtypes of cancers have been identified, with the potential to inform choices of management strategy. Biomarkers predicting response to standard therapies (such as platinum-based chemotherapy) are emerging. In several malignancies (particularly renal cell carcinoma and castration-resistant prostate cancer), targeted therapy against commonly altered signaling pathways has emerged as standard of care. Finally, targeted therapy against alterations present in rare patients (less than 2%) across diseases has the potential to drastically alter patterns of care and choices of therapeutic options.ConclusionsPrecision medicine has the highest potential to impact the care of patients. Prospective studies in the setting of clinical trials and standard of care therapy will help define reliable predictive biomarkers and new therapeutic targets leading to real improvement in patient outcomes.Patient SummaryPrecision oncology uses molecular information (DNA and RNA) from the individual and the tumor to match the right patient with the right treatment. Tremendous strides have been made in defining the molecular underpinnings of urologic malignancies and understanding how these predict response to treatment-this represents the future of urologic oncology.Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

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