Friedlander Terence W, Pritchard Colin C, Beltran Himisha
From the Division of Hematology and Medical Oncology, University of California, San Francisco, San Francisco, CA; Department of Laboratory Medicine, University of Washington, Seattle, WA; Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY.
Am Soc Clin Oncol Educ Book. 2017;37:358-369. doi: 10.1200/EDBK_175510.
Although biopsies of metastatic prostate cancer are rarely undertaken in the clinical setting, there is increasing interest in developing personalized approaches to therapy by taking into account the genetic and phenotypic changes in an individual tumor. Indeed, analysis of metastatic prostate tumors can predict sensitivity to agents that inhibit DNA repair and resistance to novel hormonal agents, such as abiraterone and enzalutamide, and identify phenotypic changes, such as neuroendocrine differentiation, that have important clinical implications. Although obtaining metastatic tumor tissue is necessary for this genomic and molecular profiling, knowing when to biopsy, selecting the appropriate metastatic lesion, and interpreting the results are major challenges facing clinicians today. In this article, we discuss the rationale for obtaining metastatic tumor tissue, review the bioinformatic approach to analyzing these specimens, discuss the timing and approach to solid and liquid tumor biopsies, review the challenges associated with obtaining and acting on clinically relevant results, and discuss opportunities for the future.
尽管在临床环境中很少对转移性前列腺癌进行活检，但通过考虑个体肿瘤的基因和表型变化来开发个性化治疗方法的兴趣日益浓厚。事实上，对转移性前列腺肿瘤的分析可以预测对抑制DNA修复药物的敏感性以及对新型激素药物（如阿比特龙和恩杂鲁胺）的耐药性，并识别具有重要临床意义的表型变化，如神经内分泌分化。虽然获取转移性肿瘤组织对于这种基因组和分子分析是必要的，但何时进行活检、选择合适的转移病灶以及解读结果是当今临床医生面临的主要挑战。在本文中，我们讨论获取转移性肿瘤组织的基本原理，回顾分析这些标本的生物信息学方法，讨论实体和液体肿瘤活检的时机和方法，回顾与获得临床相关结果并据此采取行动相关的挑战，并讨论未来的机遇。
