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系统癌症医学:迈向实现预测性、预防性、个体化和参与性(P4)医学。

Systems cancer medicine: towards realization of predictive, preventive, personalized and participatory (P4) medicine.

机构信息

Institute for Systems Biology, Seattle, WA 98109-5234, USA.

出版信息

J Intern Med. 2012 Feb;271(2):111-21. doi: 10.1111/j.1365-2796.2011.02498.x.

Abstract

A grand challenge impeding optimal treatment outcomes for patients with cancer arises from the complex nature of the disease: the cellular heterogeneity, the myriad of dysfunctional molecular and genetic networks as results of genetic (somatic) and environmental perturbations. Systems biology, with its holistic approach to understanding fundamental principles in biology, and the empowering technologies in genomics, proteomics, single-cell analysis, microfluidics and computational strategies, enables a comprehensive approach to medicine, which strives to unveil the pathogenic mechanisms of diseases, identify disease biomarkers and begin thinking about new strategies for drug target discovery. The integration of multidimensional high-throughput 'omics' measurements from tumour tissues and corresponding blood specimens, together with new systems strategies for diagnostics, enables the identification of cancer biomarkers that will enable presymptomatic diagnosis, stratification of disease, assessment of disease progression, evaluation of patient response to therapy and the identification of reoccurrences. Whilst some aspects of systems medicine are being adopted in clinical oncology practice through companion molecular diagnostics for personalized therapy, the mounting influx of global quantitative data from both wellness and diseases is shaping up a transformational paradigm in medicine we termed 'predictive', 'preventive', 'personalized', and 'participatory' (P4) medicine, which requires new strategies, both scientific and organizational, to enable bringing this revolution in medicine to patients and to the healthcare system. P4 medicine will have a profound impact on society - transforming the healthcare system, turning around the ever escalating costs of healthcare, digitizing the practice of medicine and creating enormous economic opportunities for those organizations and nations that embrace this revolution.

摘要

癌症患者的最佳治疗效果受到一个重大挑战的阻碍,这个挑战源于癌症的复杂本质:细胞异质性,以及遗传(体细胞)和环境干扰导致的众多功能失调的分子和遗传网络。系统生物学以其整体的方法来理解生物学的基本原理,以及基因组学、蛋白质组学、单细胞分析、微流控和计算策略等赋能技术,使人们能够采用一种全面的方法来研究医学,努力揭示疾病的发病机制、识别疾病生物标志物,并开始思考药物靶点发现的新策略。整合来自肿瘤组织和相应血液标本的多维高通量“组学”测量,以及新的系统诊断策略,能够识别癌症生物标志物,从而实现疾病的早期诊断、疾病分层、疾病进展评估、治疗反应评估以及复发的识别。尽管系统医学的某些方面通过个性化治疗的伴随分子诊断已在临床肿瘤学实践中得到应用,但来自健康和疾病的全球定量数据的大量涌入正在形成一种我们称之为“预测性”、“预防性”、“个体化”和“参与式”(P4)医学的变革性范例,这需要新的科学和组织策略,以便将这场医学革命带给患者和医疗保健系统。P4 医学将对社会产生深远影响——改变医疗保健系统,扭转医疗保健成本不断攀升的局面,使医学实践数字化,并为那些接受这一革命的组织和国家创造巨大的经济机遇。

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