Department of Medical Oncology, Dr. B.R.A.I.R.C.H., All India Institute of Medical Sciences, New Delhi, India.
Department of Medical Oncology, Dr. B.R.A.I.R.C.H., All India Institute of Medical Sciences, New Delhi, India.
Adv Genet. 2021;108:201-275. doi: 10.1016/bs.adgen.2021.08.004. Epub 2021 Sep 21.
Genomic characterization of lung cancer has not only improved our understanding of disease biology and carcinogenesis but also revealed several therapeutic opportunities. Targeting tumor dependencies on specific genomic alterations (oncogene addiction) has accelerated the therapeutic developments and significantly improved the outcomes even in advanced stage of disease. Identification of genomic alterations predicting response to specific targeted treatment is the key to success for this "personalized treatment" approach. Availability of multiple choices of therapeutic options for specific genomic alterations highlight the importance of optimum sequencing of drugs. Multiplex gene testing has become mandatory in view of constantly increasing number of therapeutic targets and effective treatment options. Influence of genomic characteristics on response to immunotherapy further makes comprehensive genomic profiling necessary before therapeutic decision making. A comprehensive elucidation of resistance mechanisms and directed treatments have made the continuum of care possible and transformed this deadly disease into a chronic condition. Liquid biopsy-based approach has made the dynamic monitoring of disease possible and enabled treatment optimizations accordingly. Current lung cancer management is the perfect example of "precision-medicine" in clinical oncology.
肺癌的基因组特征不仅提高了我们对疾病生物学和致癌作用的认识，而且还揭示了一些治疗机会。针对特定基因组改变（致癌基因成瘾）的肿瘤依赖性的靶向治疗加速了治疗的发展，并显著改善了即使在疾病晚期的预后。确定预测对特定靶向治疗反应的基因组改变是这种“个性化治疗”方法成功的关键。针对特定基因组改变的多种治疗选择突显了药物最佳排序的重要性。鉴于治疗靶点和有效治疗方案的数量不断增加，多基因检测已成为必需。基因组特征对免疫治疗反应的影响使得在做出治疗决策之前进行全面的基因组分析成为必要。对耐药机制的全面阐述和针对性治疗使连续护理成为可能，并将这种致命疾病转变为慢性疾病。基于液体活检的方法使得对疾病的动态监测成为可能，并能够相应地进行治疗优化。目前的肺癌管理是临床肿瘤学中“精准医学”的完美范例。
