Holch Julian Walter, Westphalen Christoph Benedikt, Hiddemann Wolfgang, Heinemann Volker, Jung Andreas, Metzeler Klaus Hans
Dtsch Med Wochenschr. 2017 Nov;142(22):1676-1684. doi: 10.1055/s-0042-120717. Epub 2017 Oct 27.
Recent developments in genomics allow a more and more comprehensive genetic analysis of human malignancies, and have sparked hopes that this will contribute to the development of novel targeted, effective and well-tolerated therapies.While targeted therapies have improved the prognosis of many cancer patients with certain tumor types, "precision oncology" also brings along new challenges. Highly personalized treatment strategies require new strategies for clinical trials and translation into routine clinical practice. We review the current technical approaches for "universal genetic testing" in cancer, and potential pitfalls in the interpretation of such data. We then provide an overview of the available evidence supporting treatment strategies based on extended genetic analysis. Based on the available data, we conclude that "precision oncology" approaches that go beyond the current standard of care should be pursued within the framework of an interdisciplinary "molecular tumor board", and preferably within clinical trials.
基因组学的最新进展使得对人类恶性肿瘤进行越来越全面的基因分析成为可能,并引发了人们的希望,即这将有助于开发新的靶向、有效且耐受性良好的疗法。虽然靶向疗法改善了许多特定肿瘤类型癌症患者的预后,但“精准肿瘤学”也带来了新的挑战。高度个性化的治疗策略需要用于临床试验以及转化为常规临床实践的新策略。我们回顾了目前癌症“通用基因检测”的技术方法,以及此类数据解读中潜在的陷阱。然后,我们概述了支持基于扩展基因分析的治疗策略的现有证据。基于现有数据,我们得出结论,超越当前护理标准的“精准肿瘤学”方法应在跨学科的“分子肿瘤委员会”框架内进行,最好是在临床试验中进行。