進行した非小細胞肺がんの患者の定期的な分子プロファイリング:フランス協同胸部インターグループ (IFCT) の1年間の全国プログラムの結果
Fabrice Barlesi1, Julien Mazieres2, Jean-Philippe Merlio3
1Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology and Therapeutic Innovations Department, Aix Marseille University, Centre d'Investigation Clinique, Marseille, France.
Lancet (London, England)
|January 19, 2016
まとめ
進行した非小細胞肺がん (NSCLC) のための定期的な分子プロファイリングは全国的に実行可能である. 遺伝子の変異を特定することで 患者の治療結果と生存率を大幅に改善します
科学分野:
- 腫瘍学
- 遺伝学
- 臨床試験
背景:
- 腫瘍発生要因の分子プロファイリングは,進行した非小細胞肺がん (NSCLC) の治療に推奨されます.
- 全国的なNSCLC分子プロファイルの実現可能性と患者のアウトカムへの影響は以前は知られていなかった.
- この政策を評価するために,フランス国立がん研究所 (INCa) が資金提供する全国的なプログラムが設立されました.
研究 の 目的:
- 先進的なNSCLC患者における全国的な分子プロファイルの実行可能性と臨床結果を評価する.
- この患者集団における特定の遺伝子変異 (EGFR,ALK,HER2,KRAS,BRAF,PIK3CA) の頻度を決定する.
- 診断された遺伝子変異が治療決定と患者の生存に与える影響を評価する.
主な方法:
- 先進的なNSCLCの患者は,28のフランスの遺伝センターで1年間 (2012年4月〜2013年4月) 連続してスクリーニングされました.
- 分子分析はEGFR,ALK,HER2,KRAS,BRAF,PIK3CAを対象とした.
- 収集されたデータには,変化の頻度,回復時間,および臨床結果 (反応率,無進行生存期,全生存期) が含まれていた.
主要な成果:
- 17,600人以上の患者が分子プロファイリングを受け,約50%の分析で遺伝的変異が見つかりました.
- EGFR変異 (11%),KRAS変異 (29%),ALK再編成 (5%) が最も頻繁な変化であった.
- 遺伝的変異の存在は,進行性および全生存率を含む全体的な応答率と生存率を大幅に改善しました.
結論:
- 先進的なNSCLCの全国的な分子分析は実行可能な戦略です.
- この研究は,遺伝子変異の検出に伴う臨床的利点を示し,その日常的な実施を支持しています.
- 許容可能な処理時間と生存率の大幅な改善は,この分子プロファイリングの方針を正当化します.
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