肿瘤精准治疗的机遇与挑战

 精准肿瘤学是基于临床病理特征和分子特征,定制可精确满足不同肿瘤患者实际需求的诊断、预后判断及治疗策略。其范畴包括精准预防(患癌风险的检测及预防性干预)、精准诊断(肿瘤早期发现与诊断,分子分型)、精准治疗(分子靶向疗法,疗效的预测与监控,基于可视化技术、细胞学和病理学以及分子表达谱评估的精准外科技术)。在精准肿瘤学时代,必须从分子层面理解肿瘤特性并进行临床决策,但仍面临诸多挑战,包括肿瘤细胞的异质性与动态进化,对肿瘤生物学特性知之甚少,基因组大数据与不精确的临床信息间的匹配问题,敏感药物少且有原因不明的耐药,缺少用于精准诊断和治疗的肿瘤生物标志物等。本文简述“精准肿瘤学”的内涵与应用、问题与挑战、今后的发展方向等,并简要介绍“液体活检”和“功能性检验”等热点领域在精准肿瘤学中的意义。

The progress and challenges of precision oncology

Precision oncology is applying established clinic-pathological indexes with molecular profiling to create diagnostic,prognostic,and therapeutic strategies precisely tailor to each patient’s requirements.It includes precision prevention (cancer risk detection and prophylactic intervention),precision diagnosis (early detection and diagnosis,molecular classification),and precision treatment (molecular targeted therapies,predicting and monitoring treatment response and precision surgery based on the combination of visual,cytology,pathologic review,as well as molecular profiling assessments).Understanding of cancer and clinical decision making from the molecular level is necessary in era of precision oncology.Many challenges,including the heterogeneity and dynamic evolution of cancer cells,few understanding about cancer biology,pairing the massive genomic data with inaccurate clinical information,limited sensitive drugs and unexplained resistance,insufficient cancer biomarkers for precision diagnosis and treatment,have to be overcome before it can be clinical routines.