Autophagy regulation in bladder cancer as the novel therapeutic strategy

Bladder cancer (BC) is the ninth most common cancer in Taiwanese male according to the Taiwan Cancer Registry Annual Report in 2014 (1). In the United State, BC is the sixth most commonly diagnosed cancer with estimated 79,030 new cases and 16,870 death in 2017 (2). The incidence and mortality rate of BC is just next to prostate cancer among the genitourinary malignancies. Almost 70–80% of patients with bladder tumors present with low-grade, superficial or non-muscle invasive bladder cancer (NMIBC) (3), others are muscle invasive bladder cancer (MIBC). Routine surveillance, repeated transurethral resection of bladder tumor (TUR-BT), and the use of intravesical agents are the standard procedures performed for initial diagnosis, staging and treatment for managing of NMIBC. Despite these efforts, there are still subset of patients who progress to MIBC that drive the mortality of these disease. While new treatment regiments are developed rapidly to manage other cancers, the treatment options for BC remains limited. It is notable that the 50% overall survival at 5 years for MIBC has not improved for almost 20 years. During the past decade, the one major change in management of BC was the introduction of neo adjuvant platinum-based chemotherapy to those patients suffering from non-metastatic MIBC. However, the overall mortality of BC has not changed. Therefore, development of novel therapeutic strategies or improvement of response rate to current therapies are critical to treat BC