Janssens Jaak Ph, Schuster Klaus, Voss Andreas
1The European Cancer Prevention Organization, Klein Hilststraat 5, 3500 Hasselt, Belgium.
Caris Life Sciences, St. Jakobsstrasse 199, 4052 Basel, Switzerland.
EPMA J. 2018 Mar 26;9(2):113-123. doi: 10.1007/s13167-018-0130-1. eCollection 2018 Jun.
Preventive, predictive, and personalized medicine (PPPM) has created a wealth of new opportunities but added also new complexities and challenges. The European Cancer Prevention Organization already embraced unanimously molecular biology for primary and secondary prevention. The rapidly exploding genomic language and complexity of methods face oncologists with exponentially growing knowledge they need to assess and apply. Tissue specimen quality becomes one major concern. Some new innovative medicines cost beyond any reasonable threshold of financial support from patients, health care providers, and governments and risk sustainability for the health care system. In this review, we evaluate the path for genomic guidance to become the standard for diagnostics in cancer care and formulate potential solutions to simplify its implementation. Basically, introduction of molecular biology to guide therapeutic decisions can be facilitated through supporting the oncologist, the pathologist, the molecular laboratory, and the interventionist. Oncologists need to know the exact indication, utility, and limitations of each genomic service. Minimal requirements on the label must be addressed by the service provider. The interventionist is there to bring the most optimal tissue sample to pathology where the tissue is expanded to a variety of appropriate liquid-based samples. The large body of results then should be translated into meaningful clinical guidance for the individual patient. Surveillance, with the appropriate application of health economic indicators, can make this system long lasting. For governments and health care providers, optimal cancer care must result in a cost-effective, resource-sustainable, and patient-focused outcome.
预防、预测和个性化医学（PPPM）创造了大量新机遇，但也带来了新的复杂性和挑战。欧洲癌症预防组织已一致认可将分子生物学用于一级和二级预防。迅速激增的基因组语言和方法的复杂性，使肿瘤学家面临着他们需要评估和应用的呈指数级增长的知识。组织标本质量成为一个主要问题。一些新型创新药物的成本超出了患者、医疗服务提供者和政府任何合理的资金支持门槛，给医疗保健系统带来了可持续性风险。在本综述中，我们评估了基因组指导成为癌症护理诊断标准的路径，并制定了简化其实施的潜在解决方案。基本上，通过支持肿瘤学家、病理学家、分子实验室和介入专家，可以促进引入分子生物学来指导治疗决策。肿瘤学家需要了解每种基因组服务的确切适应症、效用和局限性。服务提供商必须满足标签上的最低要求。介入专家负责将最佳组织样本送到病理科，在那里组织被扩展为各种合适的液体样本。然后，大量的结果应转化为针对个体患者的有意义的临床指导。通过适当应用健康经济指标进行监测，可以使这个系统持久运行。对于政府和医疗服务提供者而言，最佳的癌症护理必须产生具有成本效益、资源可持续且以患者为中心的结果。
