Hôtel-Dieu de France, Centre Hospitalier de l'Université Saint-Joseph de Beyrouth, Beirut, Lebanon.
St John of God Hospital, Subiaco, Western Australia, Australia.
Cancer J. 2019 Mar/Apr;25(2):73-79. doi: 10.1097/PPO.0000000000000358.
Improvements in systemic treatment have led to a prolongation of survival and quality of life in patients with metastatic tumors in recent years. However, despite this improved standard of care, it is expected that the progression-free survival (PFS) for patients with refractory cancers will continue to decline over subsequent therapy lines. In those patients, studies and meta-analyses showed that treatment based on multiplatform molecular profiling (MMP) of tumor tissue may derive a clinical benefit. The aim of this study was to analyze if molecular-based therapy may prolong PFS compared with the PFS of the immediately prior therapy.
We pooled clinical data of 140 patients treated within 3 recently conducted pilot studies and included an additional 21 patients who were treated within the ongoing ONCO-T-PROFILE program. The PFS of the molecular-based treatment was compared with the PFS of the previous therapy using Kaplan-Meier curves.
In heavily pretreated cancer patients, the PFS could be significantly improved using molecular-based treatment options (120.0 vs. 89.5 days). More than 50% of patients showed a clinical benefit from MMP-guided therapy as defined by a PFS ratio of 1.3 or greater.
We conclude that pretreated cancer patients can benefit from incorporation of molecular profiling, as demonstrated by not only an increase of the PFS ratio but also PFS. Further randomized trials in specific tumor subtypes may help establish specific patient populations who might benefit most from MMP guidance.
近年来，转移性肿瘤患者的系统治疗进展提高了患者的生存率和生活质量。然而，尽管有了这种改进的治疗标准，预计难治性癌症患者的无进展生存期（PFS）将继续在后续治疗线中下降。在这些患者中，研究和荟萃分析表明，基于肿瘤组织多平台分子分析（MMP）的治疗可能会带来临床获益。本研究旨在分析基于分子的治疗是否比之前的治疗更能延长 PFS。
我们汇总了 3 项最近进行的试点研究中 140 名患者的临床数据，并纳入了正在进行的 ONCO-T-PROFILE 计划中接受治疗的另外 21 名患者。使用 Kaplan-Meier 曲线比较基于分子的治疗的 PFS 与之前治疗的 PFS。
在经过大量预处理的癌症患者中，使用基于分子的治疗方案可以显著改善 PFS（120.0 天与 89.5 天）。超过 50%的患者表现出 MMP 指导治疗的临床获益，定义为 PFS 比值大于 1.3。
我们的结论是，经过预处理的癌症患者可以从分子谱分析的纳入中获益，不仅表现在 PFS 比值的增加，还表现在 PFS 的延长。在特定肿瘤亚型中进行进一步的随机试验可能有助于确定最有可能从 MMP 指导中获益的特定患者人群。
