Division of Pulmonary, Allergy and Critical Care Medicine, Thoracic Oncology Group, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Abramson Cancer Center, Philadelphia, PA, USA.
Br J Cancer. 2023 Dec;129(12):1893-1902. doi: 10.1038/s41416-023-02445-1. Epub 2023 Oct 3.
The therapeutic landscape for patients with advanced malignancies has changed dramatically over the last twenty years. The growing number of targeted therapies and immunotherapeutic options available have improved response rates and survival for a subset of patients, however determining which patients will experience clinical benefit from these therapies in order to avoid potential toxicities and reduce healthcare costs remains a clinical challenge. Cell-free circulating tumor DNA (ctDNA) is shed by tumor cells into systemic circulation and is already an integral part of routine clinical practice for the non-invasive tumor genotyping in advanced non-small cell lung cancer as well as other malignancies. The short half-life of ctDNA offers a unique opportunity to utilize early on-treatment changes in ctDNA for real-time assessment of therapeutic response and outcome, termed molecular response. Here, we provide a summary and review of the use of molecular response for the prediction of outcomes in patients with advanced cancer, including the current state of science, its application in clinic, and next steps for the development of this predictive tool.
在过去的二十年中，晚期恶性肿瘤患者的治疗环境发生了巨大变化。越来越多的靶向治疗和免疫治疗选择提高了一部分患者的反应率和生存率，然而，为了避免潜在的毒性和降低医疗成本，确定哪些患者将从这些治疗中获得临床益处仍然是一个临床挑战。无细胞循环肿瘤 DNA（ctDNA）由肿瘤细胞释放到全身循环中，已经成为常规临床实践中晚期非小细胞肺癌以及其他恶性肿瘤无创肿瘤基因分型的重要组成部分。ctDNA 的半衰期短，为利用治疗早期的 ctDNA 变化实时评估治疗反应和结果（称为分子反应）提供了独特的机会。在这里，我们总结和回顾了分子反应在预测晚期癌症患者预后中的应用，包括当前的科学状态、在临床中的应用以及开发这种预测工具的下一步。
