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[癌症的分子遗传学诊断与分子靶向治疗:精准医学时代的挑战]

[Molecular-Genetic Diagnosis and Molecular-Targeted Therapy in Cancer: Challenges in the Era of Precision Medicine].

作者信息

Miyachi Hayato

出版信息

Rinsho Byori. 2015 Oct;63(10):1188-93.

Abstract

Elucidation of the molecular pathogenesis of neoplasms and application of emerging technologies for testing and therapy have resulted in a series of paradigm shifts in patient care, from conventional to personalized medicine. This has been promoted by companion diagnostics and molecular targeted therapy, tailoring the treatment to the individual characteristics of each patient. Precision oncology has been accelerated by integrating the enhanced resolution of molecular analysis, mechanism clarity, and therapeutic relevance through genomic knowledge. In its clinical implementation, there are laboratory challenges concerning accurate measurement using stored samples, differentiation between driver and passenger mutations as well as between germline and somatic mutations, bioinformatics availability, practical decision-making algorithms, and ethical issues regarding incidental findings. The medical laboratory has a new role in providing not only testing services but also an instructive approach to users to ensure the sample quality and privacy protection of personal genome information, supporting the quality of patient practice based on laboratory diagnosis.

摘要

肿瘤分子发病机制的阐明以及新兴检测和治疗技术的应用,导致了患者护理方面的一系列范式转变,从传统医学转向个性化医学。伴随诊断和分子靶向治疗推动了这一转变,使治疗能够根据每个患者的个体特征进行定制。通过基因组学知识整合分子分析的更高分辨率、机制清晰度和治疗相关性,加速了精准肿瘤学的发展。在其临床实施过程中,存在一些实验室挑战,包括使用储存样本进行准确测量、区分驱动突变和乘客突变以及种系突变和体细胞突变、生物信息学的可用性、实用的决策算法以及关于偶然发现的伦理问题。医学实验室不仅要提供检测服务,还要为用户提供一种指导性方法,以确保样本质量和个人基因组信息的隐私保护,基于实验室诊断支持患者医疗实践的质量,从而发挥新的作用。

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