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Marcadores de ADN que predicen el beneficio del adyuvante fluorouracilo en pacientes con cáncer de colon: un estudio
P L Barratt1, M T Seymour, S P Stenning
1Academic Unit of Pathology, School of Medicine, University of Leeds, Leeds, UK.
Lancet (London, England)
|November 9, 2002
Resumen
Los marcadores moleculares pueden predecir qué pacientes con cáncer de colon se benefician de la quimioterapia con fluorouracilo. La retención de la heterocigosidad en los sitios 17p o 18q indica una respuesta positiva a la quimioterapia adyuvante.
Área de la Ciencia:
- Oncología Oncología.
- Biología Molecular Biología Molecular
- Los ensayos clínicos son ensayos clínicos.
Sus antecedentes:
- El tratamiento actual del cáncer de colon se basa en factores de pronóstico, pero se necesitan marcadores predictivos para personalizar la quimioterapia adyuvante.
- La identificación de los pacientes que se benefician más del fluorouracilo es crucial para mejorar la toma de decisiones clínicas.
Objetivo del estudio:
- Investigar marcadores moleculares para predecir la respuesta al fluorouracilo adyuvante en pacientes con cáncer de colon.
- Evaluar el valor pronóstico y predictivo de la pérdida de heterocigosidad (LOH) y la inestabilidad de los microsatélites en lugares específicos.
Principales métodos:
- Análisis de muestras normales y tumorales emparejadas de 393 pacientes con cáncer de colon en el ensayo AXIS del Reino Unido.
- Medición de la inestabilidad del LOH y del microsatélite en las localizaciones P53, D18S61, D18S851 y DP1.
- Valor pronóstico evaluado utilizando la prueba de rango logarítmico; valor predictivo evaluado utilizando la prueba de chi-cuadrado para la heterogeneidad (CSH).
Principales resultados:
- La pérdida de heterocigosidad en D18S61 fue predictiva del beneficio del fluorouracilo (CSH p=0,02), con mayor beneficio en pacientes que mantuvieron la heterocigosidad.
- La retención de la heterocigosidad en los sitios 17p o 18q se asoció con un efecto quimioterapéutico significativo (razón de riesgo 0,45), mientras que la no retención de la heterocigosidad no mostró ningún beneficio (razón de riesgo 0,91; CSH p=0,039).
Conclusiones:
- La retención de la heterocigosidad en los sitios 17p o 18q predice el beneficio del fluorouracilo adyuvante en el cáncer de colon.
- Estos hallazgos apoyan el desarrollo de marcadores moleculares para decisiones de tratamiento personalizadas en oncología.
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