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Companion Diagnostics in Clinical Therapy: Current Applications and Future Directions
Yuesong Wu1,2, Rou Xue1, Xiangwen Luo1,3
1Clinical Research Center (CRC) Medical Pathology Center (MPC) Cancer Early Detection and Treatment Center (CEDTC) and Translational Medicine Research Center (TMRC) Chongqing University Three Gorges Hospital, Chongqing University Wanzhou District Chongqing China.
Abstract:
Companion diagnostics (CDx) plays a pivotal role in precision medicine by enabling personalized treatment plans based on individual biomarker profiles. This approach can enhance therapeutic efficacy in selected indications and may reduce healthcare expenditures. Particularly in oncology, precision targeted therapies targeting pathways such as EGFR, HER2, and programmed death-1/programmed death-ligand 1 have established robust models for biomarker-driven treatment. However, rapid advancements in diagnostic technologies, expanding application scopes, and increasingly complex mechanisms of biomarker resistance are presenting new challenges for CDx. This review comprehensively examines the evolving regulatory landscape, current clinical applications across various solid tumors and hematologic malignancies, and diverse methodological platforms ranging from next-generation sequencing and immunohistochemistry to emerging liquid biopsies and point-of-care testing. It also delves into persistent barriers in CDx development, including tumor heterogeneity, test standardization, trade-offs between tissue biopsy and liquid biopsy, and the economic complexities of codevelopment and reimbursement mechanisms. By synthesizing existing knowledge and projecting future trends, this paper serves as a valuable resource for researchers, regulators, and clinicians. It provides critical insights to guide the synergistic development of drugs and diagnostics, paving the way for their integration into a more dynamic, artificial intelligence-enhanced, and multiomics-driven healthcare ecosystem.
Insights
Companion diagnostics (CDx) are crucial for precision medicine, tailoring treatments via biomarkers. This review explores CDx advancements, challenges, and future integration into AI-enhanced healthcare.
Area of Science:
- Biomarker discovery and validation
- Precision medicine and personalized therapeutics
- Diagnostic technology development
Background:
- Companion diagnostics (CDx) enable personalized treatment plans based on individual biomarker profiles, enhancing therapeutic efficacy and potentially reducing healthcare costs.
- Established models in oncology utilize targeted therapies (e.g., EGFR, HER2, PD-1/PD-L1) driven by biomarkers.
- Rapid technological advancements and complex resistance mechanisms pose challenges for CDx development and application.
Purpose of the Study:
- To comprehensively review the evolving regulatory landscape of companion diagnostics.
- To examine current clinical applications of CDx across solid tumors and hematologic malignancies.
- To explore diverse methodological platforms and persistent barriers in CDx development.
Main Methods:
- Literature review synthesizing current knowledge on CDx.
- Analysis of regulatory frameworks and clinical applications.
- Evaluation of diagnostic platforms including NGS, IHC, liquid biopsies, and point-of-care testing.
Main Results:
- Companion diagnostics are integral to precision medicine, with established roles in oncology.
- Diverse platforms exist, from traditional methods like IHC to emerging liquid biopsies and POC testing.
- Key challenges include tumor heterogeneity, standardization, biopsy trade-offs, and economic factors.
Conclusions:
- Companion diagnostics face evolving challenges but are vital for personalized medicine.
- Synergistic development of drugs and diagnostics is crucial.
- Future integration into AI-enhanced, multiomics-driven healthcare ecosystems is projected.
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