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液体活检在癌症免疫治疗中捕获肿瘤演变和临床结果的方法。

Liquid biopsy approaches to capture tumor evolution and clinical outcomes during cancer immunotherapy.

机构信息

The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Personal Genome Diagnostics, Baltimore, Maryland, USA.

出版信息

J Immunother Cancer. 2023 Jan;11(1). doi: 10.1136/jitc-2022-005924.

Abstract

Circulating cell-free tumor DNA (ctDNA) can serve as a real-time biomarker of tumor burden and provide unique insights into the evolving molecular landscape of cancers under the selective pressure of immunotherapy. Tracking the landscape of genomic alterations detected in ctDNA may reveal the clonal architecture of the metastatic cascade and thus improve our understanding of the molecular wiring of therapeutic responses. While liquid biopsies may provide a rapid and accurate evaluation of tumor burden dynamics during immunotherapy, the complexity of antitumor immune responses is not fully captured through single-feature ctDNA analyses. This underscores a need for integrative studies modeling the tumor and the immune compartment to understand the kinetics of tumor clearance in association with the quality of antitumor immune responses. Clinical applications of ctDNA testing in patients treated with immune checkpoint inhibitors have shown both predictive and prognostic value through the detection of genomic biomarkers, such as tumor mutational burden and microsatellite instability, as well as allowing for real-time monitoring of circulating tumor burden and the assessment of early on-therapy responses. These efforts highlight the emerging role of liquid biopsies in selecting patients for cancer immunotherapy, monitoring therapeutic efficacy, determining the optimal duration of treatment and ultimately guiding treatment selection and sequencing. The clinical translation of liquid biopsies is propelled by the increasing number of ctDNA-directed interventional clinical trials in the immuno-oncology space, signifying a critical step towards implementation of liquid biopsies in precision immuno-oncology.

摘要

循环肿瘤游离 DNA(ctDNA)可用作肿瘤负担的实时生物标志物,并为免疫治疗下肿瘤不断变化的分子图谱提供独特的见解。追踪 ctDNA 中检测到的基因组改变的图谱可能揭示转移级联的克隆结构,从而提高我们对治疗反应分子连接的理解。虽然液体活检可提供免疫治疗期间肿瘤负担动态的快速准确评估,但通过单一特征 ctDNA 分析并不能完全捕捉抗肿瘤免疫反应的复杂性。这凸显了需要进行整合研究,对肿瘤和免疫区室进行建模,以了解与抗肿瘤免疫反应质量相关的肿瘤清除动力学。ctDNA 检测在接受免疫检查点抑制剂治疗的患者中的临床应用已通过检测基因组生物标志物(如肿瘤突变负担和微卫星不稳定性)显示出预测和预后价值,并允许实时监测循环肿瘤负担和评估早期治疗反应。这些努力突出了液体活检在选择癌症免疫治疗患者、监测治疗效果、确定治疗最佳持续时间以及最终指导治疗选择和测序方面的新兴作用。液体活检的临床转化是由免疫肿瘤学领域中越来越多的基于 ctDNA 的干预性临床试验推动的,这是朝着在精准免疫肿瘤学中实施液体活检迈出的关键一步。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4d2d/9853269/3e699ee1720d/jitc-2022-005924f01.jpg

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