The Emergence of Precision Urologic Oncology: A Collaborative Review on Biomarker-driven Therapeutics.
The Emergence of Precision Urologic Oncology: A Collaborative Review on Biomarker-driven Therapeutics.
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DOI：
10.1016/j.eururo.2016.08.024
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发表时间：
2017-02
期刊：
影响因子：
23.4
通讯作者：
Rubin, Mark A.
中科院分区：
文献类型：
--
作者：
Barbieri, Christopher E.;Chinnaiyan, Arul M.;Lerner, Seth P.;Swanton, Charles;Rubin, Mark A.
生物标记物驱动的癌症治疗，也被称为精确肿瘤学，由于其承诺通过定义更有可能对各种治疗有效的患者亚群来改善患者结果，因此受到越来越多的关注。在这篇协作性综述文章中，我们回顾了有关泌尿系统肿瘤学中生物标记物驱动疗法的最新文献，以更好地定义该领域的状态，探索支持该方法有效性的当前证据，并评估未来的潜力。我们回顾了相关文献，特别侧重于最近关于靶向治疗、应答预测因素和生物标记物开发的研究。分子图谱的最新进展导致了泌尿系恶性肿瘤患者潜在生物标志物和预测信息的快速扩展。在疾病状态中，已经确定了癌症的不同分子亚型，并有可能为管理策略的选择提供信息。预测对标准疗法(如以铂为基础的化疗)反应的生物标记物正在出现。在几种恶性肿瘤(特别是肾细胞癌和去势抵抗的前列腺癌)中，针对通常改变的信号通路的靶向治疗已成为标准治疗方案。最后，针对罕见患者(不到2%)各种疾病的改变进行有针对性的治疗，有可能极大地改变护理模式和治疗方案的选择。精准医疗最有可能影响患者的护理。在临床试验和护理治疗标准设置方面的前瞻性研究将有助于确定可靠的预测生物标记物和新的治疗目标，从而真正改善患者的预后。精确肿瘤学使用来自个体和肿瘤的分子信息(DNA和RNA)来将正确的患者与正确的治疗相匹配。在定义泌尿系统恶性肿瘤的分子基础和了解这些基础如何预测治疗反应方面取得了巨大的进步--这代表了泌尿系统肿瘤学的未来。
Biomarker-driven cancer therapy, also referred to as precision oncology, has received increasing attention for its promise of improving patient outcomes by defining subsets of patients more likely to respond to various therapies. In this collaborative review article, we examine recent literature regarding biomarker-driven therapeutics in urologic oncology, to better define the state of the field, explore the current evidence supporting utility of this approach, and gauge potential for the future. We reviewed relevant literature, with a particular focus on recent studies about targeted therapy, predictors of response, and biomarker development. The recent advances in molecular profiling have led to a rapid expansion of potential biomarkers and predictive information for patients with urologic malignancies. Across disease states, distinct molecular subtypes of cancers have been identified, with the potential to inform choices of management strategy. Biomarkers predicting response to standard therapies (such as platinum-based chemotherapy) are emerging. In several malignancies (particularly renal cell carcinoma and castration-resistant prostate cancer), targeted therapy against commonly altered signaling pathways has emerged as standard of care. Finally, targeted therapy against alterations present in rare patients (less than 2%) across diseases has the potential to drastically alter patterns of care and choices of therapeutic options. Precision medicine has the highest potential to impact the care of patients. Prospective studies in the setting of clinical trials and standard of care therapy will help define reliable predictive biomarkers and new therapeutic targets leading to real improvement in patient outcomes. Precision oncology uses molecular information (DNA and RNA) from the individual and the tumor to match the right patient with the right treatment. Tremendous strides have been made in defining the molecular underpinnings of urologic malignancies and understanding how these predict response to treatment—this represents the future of urologic oncology.
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