Koch Christine, Trojan Joerg
Medizinische Klinik 1, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany.
Digestion. 2015;91(4):294-302. doi: 10.1159/000376573. Epub 2015 Apr 30.
Gastrointestinal cancers are among the leading causes of cancer-related deaths worldwide. In different tumor types, personalized systemic treatment strategies based upon biomarker-selection were established over the last years. Although there is a flood of targeted agents in clinical development, only a few targeted agents with a predictive biomarker could be established for the treatment of patients with gastrointestinal cancer patients so far.
Currently, predictive biomarkers for gastrointestinal cancers include Her2 overexpression or amplification (gastroesophageal adenocarcinoma), c-Kit overexpression (gastrointestinal stromal tumors) and RAS wild-type (colorectal cancer). Selection of patients based on these biomarkers allows the efficient use of targeted agents. The presence of a BRAF mutation and/or high microsatellite instability is prognostic and rather a predictive marker in CRC. Promising candidate markers in advanced clinical development are MET amplification in gastroesophageal adenocarcinoma, Met overexpression and high AFP serum levels in hepatocellular carcinoma.
Biomarker-guided systemic treatment is established in a subset of patients with gastrointestinal cancer. Ongoing clinical trials and further advances in high-throughput technologies will hopefully result in more personalized systemic treatment strategies for these patients in the near future.
胃肠道癌症是全球癌症相关死亡的主要原因之一。在过去几年中，针对不同肿瘤类型，建立了基于生物标志物选择的个性化全身治疗策略。尽管目前临床开发中有大量靶向药物，但迄今为止，仅有少数具有预测性生物标志物的靶向药物可用于治疗胃肠道癌症患者。
目前，胃肠道癌症的预测性生物标志物包括Her2过表达或扩增（胃食管腺癌）、c-Kit过表达（胃肠道间质瘤）和RAS野生型（结直肠癌）。基于这些生物标志物选择患者可实现靶向药物的有效使用。BRAF突变和/或高微卫星不稳定性在结直肠癌中具有预后意义，更确切地说是一种预测性标志物。处于临床开发后期的有前景的候选标志物包括胃食管腺癌中的MET扩增、肝细胞癌中的Met过表达和高甲胎蛋白血清水平。
生物标志物指导的全身治疗已在一部分胃肠道癌症患者中得以确立。正在进行的临床试验以及高通量技术的进一步发展有望在不久的将来为这些患者带来更个性化的全身治疗策略。
