Experimental Therapeutics and Cancer Control and Population Sciences Program, Cancer and Aging Research Program, City of Hope Comprehensive Cancer Center, 1500 E Duarte Rd, Duarte, CA, USA.
J Clin Oncol. 2010 Sep 10;28(26):4086-93. doi: 10.1200/JCO.2009.27.0579. Epub 2010 Jul 19.
A theme of personalized medicine was highlighted at the 2009 Annual Meeting of the American Society of Clinical Oncology. To this end, the current review focuses on the impact of host characteristics (such as age, sex, and comorbidity) as they pertain to cancer biology, treatment efficacy, and tolerance. Increasing age is associated with complex changes in physiology, including alterations in renal and hepatic function, and decreased bone marrow reserve. These may in turn result in alterations in pharmacokinetics and toxicity related to many commonly used anticancer agents. Using tools, such as the geriatric assessment, may help to elucidate the physiologic age of the patient as opposed to the chronologic age. Increasing age is paralleled by an increase in comorbidity, and comorbidity may have independent prognostic implications and substantially impact medical decision making in the patient with cancer. Numerous biologic ties between cancer and comorbidity exist, one example being an association of diabetes with an increased risk of disease recurrence and mortality in the setting of colon cancer. Biologic features can also vary by sex; several biomarkers with either prognostic or predictive value (ie, excisionrepair cross-complementation group 1 expression, epidermal growth factor receptor mutation, or dihydropyrimidine dehydrogenase polymorphism) may differentiate efficacy or toxicity in males and females. Taken together, age, sex, and comorbidity each encompass a complex array of physiologic and molecular variations that may each aid in personalizing care for the patient with cancer.
个性化医学是 2009 年美国临床肿瘤学会年会的一个主题。为此，本综述重点关注宿主特征（如年龄、性别和合并症）对癌症生物学、治疗效果和耐受性的影响。年龄的增长与生理的复杂变化相关，包括肾功能和肝功能的改变以及骨髓储备减少。这些变化可能导致许多常用抗癌药物的药代动力学和毒性发生改变。使用老年评估等工具可以帮助阐明患者的生理年龄，而不是实际年龄。年龄的增长伴随着合并症的增加，合并症可能具有独立的预后意义，并对癌症患者的医疗决策产生重大影响。癌症和合并症之间存在许多生物学联系，例如糖尿病与结肠癌患者疾病复发和死亡风险增加之间存在关联。生物学特征也因性别而异；一些具有预后或预测价值的生物标志物（例如，切除修复交叉互补组 1 表达、表皮生长因子受体突变或二氢嘧啶脱氢酶多态性）可能会区分男性和女性的疗效或毒性。总之，年龄、性别和合并症各自包含一系列复杂的生理和分子变化，这些变化都可能有助于为癌症患者提供个性化的护理。
