Bensalah Karim, Montorsi Francesco, Shariat Shahrokh F
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
Eur Urol. 2007 Dec;52(6):1601-9. doi: 10.1016/j.eururo.2007.09.036. Epub 2007 Oct 1.
New biomarkers are being developed to identify individuals at risk for cancer, detect disease earlier, determine prognosis, detect recurrence, predict response to particular agents, and monitor response to treatment. This article attempts to address some of the challenges facing the research and medical communities in the delivery of new biomarkers for individualized medicine.
A variety of issues and barriers can affect the transfer of clinical tests from research to clinical practice. Differences in sample collection, handling or storage, and profiling techniques may influence the protein profile obtained by any method.
Standard procedures and quality check schemes are necessary because there is a lack of definition to guarantee reproducibility of new procedures. From technical and economic viewpoints, the assay has to be sufficiently robust to be completed in community-based hospitals. Although traditionally cancer patients were treated with drugs of low toxicity or of high tolerance regardless of their efficacy in a given patient if the benefits of that drug are proven in both experimental and clinical conditions, recent advances have provided opportunities to adapt "tailored" treatment modalities. The evolving trend is the usage of patterns of markers instead of a single marker. Further challenges in biomarker development are in finding the relevant markers that have the right degree of specificity and sensitivity and a reliable test to measure the outcome.
Discovery, testing, and validation of clinically appropriate and commercially useful tumor markers should permit individualization of therapy.
新型生物标志物正在不断研发,用于识别癌症高危个体、更早地检测疾病、确定预后、检测复发、预测对特定药物的反应以及监测治疗反应。本文旨在探讨研究界和医学界在为个体化医疗提供新型生物标志物方面所面临的一些挑战。
多种问题和障碍会影响临床试验从研究向临床实践的转化。样本采集、处理或储存以及分析技术的差异可能会影响通过任何方法获得的蛋白质谱。
由于缺乏保证新程序可重复性的定义,因此需要标准程序和质量检查方案。从技术和经济角度来看,该检测方法必须足够稳健,以便能在社区医院完成。传统上,癌症患者无论药物对特定患者的疗效如何,都接受低毒性或高耐受性的药物治疗,前提是该药物在实验和临床条件下均已证明其益处。然而,最近的进展为采用“量身定制”的治疗方式提供了机会。目前的发展趋势是使用标志物模式而非单一标志物。生物标志物开发面临的进一步挑战在于找到具有适当特异性和敏感性的相关标志物,以及一种可靠的检测方法来衡量结果。
发现、测试和验证临床适用且具有商业价值的肿瘤标志物应能实现治疗的个体化。