精准肿瘤学液体活检的最新进展:肺癌中新兴的生物标志物及临床应用

Recent advances in liquid biopsy for precision oncology: emerging biomarkers and clinical applications in lung cancer.

作者信息

Bazan Russo Tancredi Didier, Pepe Francesco, Gristina Valerio, Gottardo Andrea, Russo Gianluca, Scimone Claudia, Palumbo Lucia, Busuito Giulia, Incorvaia Lorena, Guerry Juliette Aimee, Galvano Antonio, Badalamenti Giuseppe, Bazan Viviana, Troncone Giancarlo, Russo Antonio, Malapelle Umberto

机构信息

Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy.

Department of Public Health, University of Naples Federico II, Naples, Italy.

出版信息

Future Oncol. 2025 Aug 5:1-19. doi: 10.1080/14796694.2025.2542051.

Abstract

Lung Cancer (LC) remains the leading cause of cancer-related mortality. While Tissue Biopsy (TB) remains the gold standard for molecular profiling, its invasiveness and inability to provide real-time monitoring have led to the adoption of Liquid Biopsy (LB) as a minimally invasive alternative. By analyzing different circulating analytes such as cell-free DNA (cfDNA), circulating tumor DNA (ctDNA), Circulating Tumor Cells (CTCs), Extracellular Vesicles (EVs), and Tumor-Educated Platelets (TEPs), LB offers a dynamic approach to assessing tumor heterogeneity, Minimal Residual Disease (MRD), and treatment resistance. Recent clinical trials have underscored their role in guiding therapy decisions and monitoring treatment response. In early-stage disease, several Randomized Clinical Trials (RCTs) have shown that ctDNA clearance predicts survival benefits in patients receiving neoadjuvant or perioperative Immune Checkpoint Inhibitors (ICIs). Additionally, adjuvant RCTs have confirmed the ctDNA prognostic role in post-surgical relapse risk assessment. Despite its transformative potential, challenges such as assay standardization, sensitivity limitations in early-stage disease, and regulatory barriers remain. As ongoing research continues to validate its clinical utility, LB is poised to become an indispensable tool in the precision management of LC.

摘要

肺癌(LC)仍然是癌症相关死亡的主要原因。虽然组织活检(TB)仍然是分子谱分析的金标准,但其侵入性以及无法提供实时监测,导致液体活检(LB)作为一种微创替代方法被采用。通过分析不同的循环分析物,如游离DNA(cfDNA)、循环肿瘤DNA(ctDNA)、循环肿瘤细胞(CTC)、细胞外囊泡(EV)和肿瘤衍生血小板(TEP),LB提供了一种动态方法来评估肿瘤异质性、微小残留病(MRD)和治疗耐药性。最近的临床试验强调了它们在指导治疗决策和监测治疗反应方面的作用。在早期疾病中,几项随机临床试验(RCT)表明,ctDNA清除率可预测接受新辅助或围手术期免疫检查点抑制剂(ICI)治疗的患者的生存获益。此外,辅助RCT已证实ctDNA在术后复发风险评估中的预后作用。尽管LB具有变革潜力,但仍存在诸如检测标准化、早期疾病敏感性限制和监管障碍等挑战。随着正在进行的研究继续验证其临床实用性,LB有望成为LC精准管理中不可或缺的工具。

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