Department of Haematology-Oncology, National University Cancer Institute, Singapore.
Ann Acad Med Singap. 2011 Aug;40(8):362-8.
Personalising cancer treatment to optimise therapeutic efficacy while minimising exposure to the toxicities of ineffective drugs is the holy grail of medical oncology. Clinical parameters and conventional histopathological characterisations of cancers are no longer adequate to guide the practising oncologists in treatment planning. The explosion of knowledge in cancer molecular biology has led to the availability of tumour-specific molecules that serve as predictive and prognostic markers. In breast cancer, HER-2 positivity is a good predictor for success of anti-HER-2 trastuzumab monoclonal antibody therapy. K-ras mutational status predicts the likelihood of response to anti-EGFR monoclonal antibodies in advanced colorectal cancers. Similarly, EGFR mutational status in pulmonary adenocarcinoma is highly predictive for responses or otherwise to tyrosine kinase inhibitors. Notwithstanding our deeper understanding of tumour biology and the availability of predictive and prognostic laboratory tools, we are still far from achieving our dream of the perfect personalised cancer treatment, as each tumour in a particular patient is unique to itself. A much coveted, real-time, anti-tumour drug sensitivity testing in the future may one day pave the way for truly treating the right tumour with the right drug in the right patient.
将癌症治疗个体化以优化治疗效果，同时将无效药物的毒性暴露最小化，是肿瘤医学的圣杯。临床参数和癌症的常规组织病理学特征已不足以指导肿瘤临床医生进行治疗规划。癌症分子生物学知识的爆炸式增长导致了肿瘤特异性分子的出现，这些分子可作为预测和预后标志物。在乳腺癌中，HER-2 阳性是抗 HER-2 曲妥珠单抗单克隆抗体治疗成功的良好预测指标。K-ras 突变状态预测晚期结直肠癌对抗 EGFR 单克隆抗体的反应可能性。同样，肺腺癌中的 EGFR 突变状态高度预测对酪氨酸激酶抑制剂的反应或无反应。尽管我们对肿瘤生物学有了更深入的了解，并且有了预测和预后的实验室工具，但我们离实现完美的个体化癌症治疗的梦想还很远，因为特定患者的每个肿瘤都是独一无二的。未来，人们渴望进行实时的抗肿瘤药物敏感性测试，这可能有一天会为用正确的药物在正确的患者中治疗正确的肿瘤铺平道路。
