Center for Childhood Cancer, Nationwide Children's Hospital, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio.
Department of Molecular Oncology, BC Cancer, Provincial Health Services Authority, Vancouver, British Columbia, Canada.
Cancer. 2019 Oct 15;125(20):3514-3525. doi: 10.1002/cncr.32351. Epub 2019 Jul 29.
Patients who are diagnosed with osteosarcoma (OS) today receive the same therapy that patients have received over the last 4 decades. Extensive efforts to identify more effective or less toxic regimens have proved disappointing. As we enter a postgenomic era in which we now recognize OS not as a cancer of mutations but as one defined by p53 loss, chromosomal complexity, copy number alteration, and profound heterogeneity, emerging threads of discovery leave many hopeful that an improving understanding of biology will drive discoveries that improve clinical care. Under the organization of the Bone Tumor Biology Committee of the Children's Oncology Group, a team of clinicians and scientists sought to define the state of the science and to identify questions that, if answered, have the greatest potential to drive fundamental clinical advances. Having discussed these questions in a series of meetings, each led by invited experts, we distilled these conversations into a series of seven Provocative Questions. These include questions about the molecular events that trigger oncogenesis, the genomic and epigenomic drivers of disease, the biology of lung metastasis, research models that best predict clinical outcomes, and processes for translating findings into clinical trials. Here, we briefly present each Provocative Question, review the current scientific evidence, note the immediate opportunities, and speculate on the impact that answered questions might have on the field. We do so with an intent to provide a framework around which investigators can build programs and collaborations to tackle the hardest problems and to establish research priorities for those developing policies and providing funding.
目前,被诊断为骨肉瘤(OS)的患者接受的治疗方法与过去 40 年来的治疗方法相同。尽管人们付出了大量努力来寻找更有效或毒性更小的方案,但结果令人失望。随着我们进入后基因组时代,我们现在认识到 OS 不是一种由突变引起的癌症,而是一种由 p53 缺失、染色体复杂性、拷贝数改变和明显异质性定义的疾病。不断出现的新发现让人们充满希望,即对生物学的深入理解将推动临床护理的改善。在儿童肿瘤学组骨肿瘤生物学委员会的组织下,一组临床医生和科学家试图确定该领域的现状,并确定如果得到回答,最有可能推动基础临床进展的问题。在一系列会议上讨论了这些问题,每次会议都由特邀专家主持,我们将这些讨论浓缩成了七个发人深省的问题。这些问题包括引发致癌的分子事件、疾病的基因组和表观基因组驱动因素、肺转移的生物学、最能预测临床结果的研究模型,以及将研究发现转化为临床试验的过程。在这里,我们简要介绍了每个发人深省的问题,回顾了当前的科学证据,指出了当前的机会,并推测了回答这些问题可能对该领域产生的影响。我们这样做的目的是提供一个框架,让研究人员可以在这个框架内构建项目和合作,以解决最困难的问题,并为制定政策和提供资金的人确定研究重点。
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