Gray Mark, Meehan James, Turnbull Arran K, Martínez-Pérez Carlos, Kay Charlene, Pang Lisa Y, Argyle David J
The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Scotland, United Kingdom.
Translational Oncology Research Group, Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Scotland, United Kingdom.
Front Vet Sci. 2020 Nov 12;7:598338. doi: 10.3389/fvets.2020.598338. eCollection 2020.
Treating individual patients on the basis of specific factors, such as biomarkers, molecular signatures, phenotypes, environment, and lifestyle is what differentiates the precision medicine initiative from standard treatment regimens. Although precision medicine can be applied to almost any branch of medicine, it is perhaps most easily applied to the field of oncology. Cancer is a heterogeneous disease, meaning that even though patients may be histologically diagnosed with the same cancer type, their tumors may have different molecular characteristics, genetic mutations or tumor microenvironments that can influence prognosis or treatment response. In this review, we describe what methods are currently available to clinicians that allow them to monitor key tumor microenvironmental parameters in a way that could be used to achieve precision medicine for cancer patients. We further describe exciting novel research involving the use of implantable medical devices for precision medicine, including those developed for mapping tumor microenvironment parameters (e.g., O, pH, and cancer biomarkers), delivering local drug treatments, assessing treatment responses, and monitoring for recurrence and metastasis. Although these research studies have predominantly focused on and were tailored to humans, the results and concepts are equally applicable to veterinary patients. While veterinary clinical studies that have adopted a precision medicine approach are still in their infancy, there have been some exciting success stories. These have included the development of a receptor tyrosine kinase inhibitor for canine mast cell tumors and the production of a PCR assay to monitor the chemotherapeutic response of canine high-grade B-cell lymphomas. Although precision medicine is an exciting area of research, it currently has failed to gain significant translation into human and veterinary healthcare practices. In order to begin to address this issue, there is increasing awareness that cross-disciplinary approaches involving human and veterinary clinicians, engineers and chemists may be needed to help advance precision medicine toward its full integration into human and veterinary clinical practices.
基于生物标志物、分子特征、表型、环境和生活方式等特定因素对个体患者进行治疗，这正是精准医疗计划与标准治疗方案的区别所在。尽管精准医疗几乎可以应用于医学的任何分支，但它可能最容易应用于肿瘤学领域。癌症是一种异质性疾病，这意味着即使患者在组织学上被诊断为同一癌症类型，他们的肿瘤可能具有不同的分子特征、基因突变或肿瘤微环境，这些都会影响预后或治疗反应。在本综述中，我们描述了临床医生目前可采用哪些方法来监测关键的肿瘤微环境参数，从而实现癌症患者的精准医疗。我们还进一步描述了令人兴奋的新型研究，这些研究涉及使用可植入医疗设备实现精准医疗，包括那些用于绘制肿瘤微环境参数（如氧气、pH值和癌症生物标志物）、进行局部药物治疗、评估治疗反应以及监测复发和转移的设备。尽管这些研究主要集中于人类并针对人类进行了调整，但结果和概念同样适用于兽医患者。虽然采用精准医疗方法的兽医临床研究仍处于起步阶段，但已经有了一些令人兴奋的成功案例。其中包括开发用于犬肥大细胞瘤的受体酪氨酸激酶抑制剂，以及生产用于监测犬高级别B细胞淋巴瘤化疗反应的PCR检测方法。尽管精准医疗是一个令人兴奋的研究领域，但目前它尚未在人类和兽医医疗实践中得到显著应用。为了开始解决这个问题，人们越来越意识到，可能需要涉及人类和兽医临床医生、工程师和化学家的跨学科方法，以帮助推动精准医疗全面融入人类和兽医临床实践。
